Active Surveillance For The Management Of Prostate Cancer In A Contemporary Cohort

Main Category: Urology / Nephrology
Also Included In: Prostate / Prostate Cancer;  Cancer / Oncology
Article Date: 27 Jun 2008 - 1:00 PDT

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UroToday.com - In the online version of Cancer, Dr. Marc Dall'Era and colleagues at UCSF report on their experience with active surveillance (AS) for prostate cancer (CaP). Active surveillance was offered to men with Gleason score <6, PSA <10ng/ml, no Gleason grade 4 or 5 cancer, less than 33% of biopsy cores involved, and clinical T1/T2a tumors. Surveillance consisted of serial PSA measurements with DRE at 3 month intervals, TRUS at 6-12 month intervals, and repeat prostate biopsies at 12-24 month intervals. Active treatment was the primary outcome.

Since 1991, 321 men went on AS and met criteria for this analysis. The mean PSA level at diagnosis was 6.5ng/ml, median Gleason score was 6, mean percent of positive cores was 20.3%, and mean patient age was 63.4 years. Patients were stratified as low risk in 71%, intermediate risk in 26% and high risk in 3%. This suggests inclusion of patients who did not meet strict entry criteria but elected AS. Median patient follow-up was 3.6 years. At least 2 prostate biopsies to evaluate for grade progression were performed in 51%, and at least 3 PSA levels were available in 95% to calculate PSA velocity.

Definitive therapy was performed in 78 men (24%) at a median time of 3 years; 26 underwent radical prostatectomy, 35 had radiotherapy alone, 7 had radiotherapy with androgen deprivation therapy, and 9 received primary androgen deprivation therapy. Clinical evidence of progression occurred in 52 treated patients, and 26 men were treated because of personal choice. A PSAV >0.75ng/ml/year occurred in 78 men and 15% had a PSAV >2ng/ml/year. Mean PSA doubling time was 6.7 years and 38% of the cohort had an increase in Gleason score on repeat biopsy.

The overall actuarial probabilities of not receiving treatment at 2 and 5 years were 85% and 67%, respectively. Men who had an increase in Gleason score on biopsy were 3.9 times as likely to convert to active treatment as men who had no increase.

Dall'era MA, Konety BR, Cowan JE, Shinohara K, Stauf F, Cooperberg MR, Meng MV, Kane CJ, Perez N, Master VA, Carroll PR

Cancer. 2008 Apr 23 (Epub ahead of print)
doi:10.1002/cncr.23502

Reported by UroToday.com Contributing Editor Christopher P. Evans, MD, FACS

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