Prostate Cancer Outcomes In A Cohort Of Screened Patients Suitable For Active Surveillance

Active surveillance (AS) is an option for low risk prostate cancer (CaP). Defining criteria for AS is in evolution. A report from Dr. Roemeling and colleagues in Rotterdam, The Netherlands and Toronto, Canada appears in the epub version of European Urology and provides the outcomes of screened men who selected various management strategies for their low-risk CaP.

Between 1993 and 1999 21,210 men were randomized to the screening arm of the Netherlands cohort of the European Randomized Study of Screening for Prostate Cancer. Acceptable criteria for AS were defined as Gleason score 6 (3+3) or lower, < 2 cores involved with CaP, clinical stage T1c or T2, a PSA density of <0.2ng/ml/cc, and a PSA level <15ng/ml. Of screened men, 1,014 were diagnosed with CaP and 293 (29.8%) of these met the criteria as defined for AS. This study population had a mean age of 66 years, a mean PSA level of 4.8ng/ml and 64% were stage T1c.

Radical prostatectomy was elected by 136/293 men, (46.4%), radiotherapy by 91 patients (31.3%) and AS by 64 men (21.8%). Mean tumor volume in surgical specimens was 0.24ml, and in 34 specimens the tumor volume was >0.05ml. Stage pT3a disease was present in only 5 specimens and pT3b disease present in one. Only 3/91 men electing radiotherapy choose brachytherapy, with the other 88 men receiving external beam radiotherapy. Of the 64 patients electing AS, 19 (30%) received deferred treatment after a median of 40 months. The majority of these men elected radiotherapy as their eventual treatment.

Over a mean follow-up period of 80 months, 3 men died from CaP, and 40 died from intercurrent disease. The 3 CaP deaths occurred in 1 surgery and 2 radiotherapy patients. The CaP specific survival at 8 years was 99.2% and the overall survival was 85.4%. Metastatic disease was documented in 2 surgery and 2 radiotherapy patients, of whom 3 died from CaP. PSA progression was noted in 13 surgery patients (9.6%) and 16 radiotherapy men (17.6%). The 8-year biochemical progression-free survival was 89.8% in surgery patients, 71.7% in radiotherapy patients and 100% in AS patients. No man who was managed with AS developed metastatic disease or died from CaP.

These data suggest that men selected for AS by the defined criteria do well with 8 years of follow-up. However, the authors note that undersampling of CaP may be a potential limitation of the study.

By Christopher P. Evans, M.D.

Reference:
Eur Urol 2006;epub
Link Here.

UroToday - the only urology website with original content written by global urology key opinion leaders actively engaged in clinical practice.

To access the latest urology news releases from UroToday, go to:
http://www.urotoday.com

Copyright © 2006 - UroToday