OBJECTIVE: To analyze how patients enrolled in our biopsy-based surveillance program would fare under the PRIAS protocol which utilizes PSA kinetics.
PATIENTS AND METHODS: Since 1995, 1,125 men with very low risk prostate cancer have enrolled in the AS program at the Johns Hopkins Hospital (JHH) which is based on monitoring with annual biopsy. The PRIAS protocol utilizes a combination of periodic biopsies (in years 1, 4, and 7) and PSA doubling time (PSADT) to trigger intervention. Patients enrolled in the JHH AS program were retrospectively reviewed to evaluate how the use of the PRIAS protocol would alter the timing and utilization of curative intervention.
RESULTS: Over a median of 2.1 years of follow up, 38% of men in the JHH AS program experienced biopsy reclassification. Of those, 62% were detected at biopsy intervals corresponding to the PRIAS criteria, while 16% were detected between scheduled PRIAS biopsies, resulting in a median delay in detection of 1.9 years. Of 202 with >5 years of follow up, 11% of men in the JHH program were found to have biopsy reclassification after it would have been identified in the PRIAS protocol, resulting in a median delay of 4.7 years to reclassification. 12% of patients who would have undergone immediate intervention under PRIAS due to abnormal PSA kinetics would never have undergone reclassification on the JHH protocol and thus would not have undergone definitive intervention.
CONCLUSIONS: There are clear differences between PSA kinetics based AS programs and biopsy based programs. Further studies should address whether and how the differences in timing of intervention impact subsequent disease progression and prostate cancer mortality.
Written by:
Kates M, Tosoian JJ, Trock BJ, Feng Z, Carter HB, Partin AW. Are you the author?
James Buchanan Brady Urological Institute, Johns Hopkins Medical Institutions, Baltimore, MD, USA.
Reference: BJU Int. 2014 Jun 6. Epub ahead of print.
doi: 10.1111/bju.12828
PubMed Abstract
PMID: 24904995
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