Overall Versus Disease-Specific Survival Of Screen-Detected Prostate Cancer Patients Who Were Initially Managed Expectantly

Main Category: Prostate / Prostate Cancer
Also Included In: Urology / Nephrology;  Clinical Trials / Drug Trials
Article Date: 09 Jun 2008 - 1:00 PDT

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ORLANDO, FL (UroToday.com) - Researchers from the Netherlands report on a new active surveillance program. PRIAS (Prostate cancer Research International: Active Surveillance) is a new international active surveillance program. The current retrospective study gives insight into the overall and cause-specific survival of screen-detected men who were initially managed expectantly and would have complied with the PRIAS inclusion criteria.

The PRIAS inclusion criteria are: 1. PSA at diagnosis 10ng/mL or less 2. PSA density <0.2ng/mL/cc 3. Clinical stage T1c or T2 (Nx/0 Mx/0) 4. One or two biopsy cores invaded with prostate cancer 5. Biopsy Gleason score 3+3=6 or less. These were retrospectively measured against the 1,629 prostate cancers detected in the first two screen rounds of the ERSPC; Rotterdam section. Diagnoses were based on lateralized sextant biopsies. The causes of death were reviewed by an independent committee and were complete until January 2006.

Of 628 screen-detected cancers who matched the PRIAS inclusion criteria (39%, 628/1,629), 183 men (29%183/28) choose for an expectant policy, 148 participants from round one and 218 from screen round 2 (40% of 550 men diagnosed in round 2). The median PSA level at diagnosis was 4.0ng/mL. The median age was 67 years (25-75p 63-70). During the mean follow-up of 6.6 years a total of 26 men (14%) died; none died from prostate cancer. The calculated ten-year overall survival was 77%, which is in sharp contrast with the calculated 10-year cause specific survival of 100%.

Based on the entry criteria and the 100% disease-specific survival, a large proportion of men in the contemporary screening series would have been candidates for active surveillance. Although counseling was based on sextant biopsies, after a mean follow-up of 6.6 years already 14% of men initially managed with expectant management had died as a result of other causes, while none from prostate cancer. Further follow-up is planned.

Presented by Stijn Roemeling, Roderick C N van den Bergh, Andre N Vis, Monique J Roobol, Chris H Bangma, Fritz H Schrode at the Annual Meeting of the American Urological Association (AUA) - May 17 - 22, 2008. Orange County Convention Center - Orlando, Florida, USA.

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

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