Little is known as to the potential for over-treatment of young men diagnosed with prostate cancer.
We show that for men aged ≤ 55 years with PSA screen-detected disease, 45% of the tumours are classified as very low risk and 85% of these have favourable pathology, yet most are actively treated. These findings raise the spectre of over-treatment for a group of men likely to be affected by treatment side-effects.
OBJECTIVE: To identify a population of young men (aged < 55 years at diagnosis) with very-low-risk prostate cancer (stage cT1c, with prostate-specific antigen [PSA] density of < 0.15 ng/mL/g, Gleason score ≤ 6, and ≤ 2 positive biopsy cores with < 50% tumour involvement) that may be candidates for active surveillance (AS).
PATIENTS AND METHODS: We queried a Department of Defense tumour registry and hard-copy records for servicemen diagnosed with prostate cancer from 1987 to 2010. Statistical analyses were undertaken using Fisher's exact and chi-square testing.
RESULTS: From 1987-1991 and 2007-2010, PSA screen-detected tumours diagnosed in men aged ≤ 55 years rose >30-fold. Data for a subset of men (174) with PSA screen-detected cancer were evaluable for disease risk assessment. Of the 174 men with screen-detected disease, 81 (47%) had very-low-risk disease. Of that group, 96% (78/81) selected treatment and, of 57 men undergoing radical prostatectomy (RP), the tumours of 49 (86%) carried favourable pathology (organ confined, < 10% gland involvement, Gleason ≤ 6).
CONCLUSIONS: Nearly half of young men with PSA screen-detected prostate cancer are AS candidates but the overwhelming majority seek treatment. Considering that many tumours show favourable pathology at RP, there is a possibility that these patients may benefit from AS management.
Written by:
Kim J, Ebertowski J, Janiga M, Arzola J, Gillespie G, Fountain M, Soderdahl D, Canby-Hagino E, Elsamanoudi S, Gurski J, Davis JW, Parker PA, Boyd DD. Are you the author?
Department of Genitourinary Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
Reference: BJU Int. 2013 Jan 25. Epub ahead of print.
doi: 10.1111/j.1464-410X.2012.11768.x
PubMed Abstract
PMID: 23350937
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