OBJECTIVE: To evaluate clinical and pathological factors that influence the risk for disease progression in a cohort of patients with low-intermediate risk prostate cancer (PCa) under active surveillance (AS).
PATIENTS AND METHODS: We studied a total of 300 patients diagnosed between 1992 and 2012 with prostate adenocarcinoma with favorable parameters or who refused treatment and were managed with AS. Of those, 155 patients with at least 1 repeat biopsy and no progression criteria at the time of the diagnosis were included for statistical analyses. Patients were followed every 3-6 months for prostate-specific antigen (PSA) measurement and physical examination (PE). Patients were offered repeat prostatic biopsy every year. Disease progression was defined as the presence of one or more of the following criteria: ≥3 positive cores, >50% of cancer in at least 1 core, and a predominant Gleason pattern of 4.
RESULTS: For the 155 patients, the mean age (SD) at diagnosis was 67 (7) years; median follow-up was 5.4 years (interquartile range [IQR], 3.6-9.5 years). Of these, 67 patients, 25 patients, 6 patients, and 2 patients had 2, 3, 4, and 5 repeat biopsies, respectively. At baseline, 11 (7%) patients had a Gleason score (GS) of 3+4, while the remaining 144 (93%) patients had a GS of ≤ 6. A total of 50 (32.3%) patients showed disease progression on repeat biopsies, with a median progression-free survival time of 7 years. The rate of disease progression decreased after the second repeat biopsy. The 5-year overall survival rate was 100%. Having a PSA density (PSAd) of >0.15, >1 positive core, and GS >6 at the time of the diagnosis was associated with a significantly higher rate of disease progression on univariate analysis (P< 0.05), while a maximum percentage of cancer in any core of >10% showed a trend toward significance for a higher progression rate (P=0.054). On multivariate analysis, only the presence of PSAd >0.15 remained significant for a higher progression rate (P< 0.05). Of 155 patients, 5 (3.2%) subsequently received radiotherapy, 13 (8.4%) received hormonal therapy, and 13 (8.4%) underwent radical prostatectomy.
CONCLUSION: AS is a suitable management option for patients with clinically low-risk PCa. A PSAd of >0.15 ng/ml/cc is an important predictor for disease progression.
Written by:
Barayan GA, Brimo F, Bégin LR, Hanley JA, Liu Z, Kassouf W, Aprikian AG, Tanguay S. Are you the author?
Department of Surgery (Division of Urology), McGill University, Montreal, Canada.
Reference: BJU Int. 2014 Mar 31. Epub ahead of print.
doi: 10.1111/bju.12754
PubMed Abstract
PMID: 24684511
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