ORLANDO, FL, USA (UroToday.com) - Chris Parker, Royal Hospital (Sutton, UK) -- The methods of active surveillance are changing: "While we know that monitoring PSA levels over time is not as useful as we once thought, a stable PSA in the first two years after diagnosis does not preclude the possibility of a lethal prostate cancer.
PSA levels can fluctuate further challenging the clinician to relate this fluctuation to cancer progression. The future of AS now includes men with intermediate-risk disease." For example, current guidelines for AS in regards to the detection of Gleason score 7 cancer suggests radical treatment, but the PIVOT data indicates this approach may lead to unnecessary over treatment in many men. He concluded by saying, "Active surveillance offers men with favorable-risk, localized prostate cancer the hope of avoiding unnecessary treatment. The use of MP MRI may eliminate the need to repeat biospy while identifying the need to treat in others. AS may also be a viable option for select men with either low- or intermediate-risk prostate cancer."
Ian M. Thompson, on understanding the U.S. Preventive Services Task Force's recommendation on PSA screening...Dr. Thompson outlined four clear steps if PSA testing is used.:
- Inform the patient of the risks/benefits of PSA testing
- Whichever physician receives the PSA test result, (and considers referral to the urologist for biopsy) consider: a) risk of cancer detection; b) the risk of detection for consequential cancers; and c) risk of detection of indolent tumors.
- When a biopsy is performed, a cancer is detected as low-grade, low-volume, inform the patient that there is no evidence that treatment will reduce prostate cancer mortality and active surveillance is an option.
- For men with high-grade or high-volume prostate cancer, combination therapies have the greatest impact (for example, radiation + ADT and the use of adjuvant radiation post-surgery).
"PSA testing is most beneficial when we fully understand the nuances of its application. Simply testing men to maximize cancer detection and thereafter treat ALL cancers detected will likely lead to net harm." (as was the conclusion of the USPSTF). "We now have new clinical trial outomes to help the practitioner implement intelligent PSA testing."
Presented by Chris Parker, and Ian M. Thompson, at the 2013 Genitourinary Cancers Symposium - February 14 - 16, 2013 - Rosen Shingle Creek - Orlando, Florida USA
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Reported by Karen Roberts, medical editor for UroToday.com