Prospective Study Of Determinants And Outcomes Of Deferred Treatment Or Watchful Waiting Among Men With Prostate Cancer In A Nationwide Cohort

Main Category: Prostate / Prostate Cancer
Article Date: 01 Dec 2009 - 0:00 PDT

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UroToday.com - In the online edition of the Journal of Clinical Oncology, Dr. William Shappley and associates reported on a prospective cohort of men with prostate cancer (CaP) who were followed with active surveillance with deferred treatment (DT) intervention.

The participants were from the Health Professionals Follow-up Study (HPFS). The HPFS is an ongoing nationwide prospective group of 51,529 men initially enrolled in 1986. Since 1986, participants completed a health questionnaire every 2 years. Between 1986 and 2007, 3,662 men reported a diagnosis of CaP, and after exclusions for incomplete data, 3,331 men remained for the analysis. Active treatment was selected by 2,989 men, and DT was elected by 342 men. DT was defined as no treatment for at least one year after the data of CaP diagnosis. Study endpoints included time to initiation of active treatment and time to metastasis or death from CaP. Demographic, clinical, and pathologic variables were included as covariates in the analysis.

DT patients had a mean follow-up time of 8.3 years. Men undergoing DT had significantly lower Gleason score, clinical stage, lower PSA at diagnosis, older age at diagnosis (4.8 years), and were 0.4 inches shorter. No men younger than age 50 elected DT. Among the 342 men electing DT, 174 (51%) remained untreated with 7.7 years mean follow-up. Those converting to active treatment (168 men) did so at an average of 3.9 years after diagnosis. Significant predictors of conversion to active treatment after one year included younger age at diagnosis, higher clinical stage, higher PSA, higher Gleason score, or worse risk group stratification. On multivariate analysis, age at diagnosis, clinical stage, PSA at diagnosis, and Gleason score remained significant predictors of eventual active treatment. Patients who were high-risk had a 60% likelihood to undergo treatment within 5 years, compared to 39% for intermediate risk-men and 38% for low-risk men. In multivariate analysis, risk category, Gleason score, clinical stage and PSA were strongly predictive of metastasis or CaP death. However, DT compared with immediate treatment was not associated with any significant increase in CaP mortality or metastasis.

Shappley WV 3rd, Kenfield SA, Kasperzyk JL, Qiu W, Stampfer MJ, Sanda MG, Chan JM

J Clin Oncol. 2009 Oct 20;27(30):4980-5
doi:10.1200/JCO.2008.21.2613

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Contributing Editor Christopher P. Evans, MD, FACS

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