PURPOSE: There is growing conflict in the literature describing the effect of delayed treatment on outcomes following radical prostatectomy.
There is also evidence to suggest progression of low-risk prostate cancer to develop higher grades and volumes of prostate cancer during active surveillance. It is unknown as to what affect a delay in referral of those men with abnormal screened-PSA levels have on subsequent Gleason grade.
METHODS: We identified 350 men through our rapid access prostate clinic who underwent TRUS biopsy for abnormal age-related PSA and/or abnormal clinical examination. Clinicopathological findings were compared for those with positive versus negative TRUS biopsies, and for those with initial delays in referral (< 12 months, 12-18 months, and >18 months). We used ANOVA and Student's t-tests amongst other statistical tools to examine significance of clinical findings.
RESULTS: Of the 350 men who underwent TRUS biopsy, those with a delay in referral of 12 months or more were significantly associated with higher PSA titers, clinically palpable disease and likelihood of diagnosis with prostate cancer. A delay of 18 months or more led to a significantly higher risk of being diagnosed with a leading grade 4 prostate cancer, which was further supported using PSA velocity as a diagnostic tool (change >0.4 ng/ml/year).
CONCLUSION: We recommend that repeated asymptomatic abnormal age-related PSA readings and/or abnormal clinical examination in the screened population be referred without delay to a urologist for further assessment, enrolment into an active surveillance program or definitive subsequent treatment.
Written by:
O'Kelly F, Thomas A, Murray D, Galvin D, Mulvin D, Quinlan DM. Are you the author?
Department of Urological Surgery, St. Vincent's University Hospital, Elm Park, Dublin, Ireland.
Reference: Prostate. 2013 May 8. Epub ahead of print.
doi: 10.1002/pros.22628
PubMed Abstract
PMID: 23657938
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