Careful selection and close monitoring of low-risk prostate cancer patients on active surveillance minimizes the need for treatment

Mark S. Soloway, Cynthia T. Soloway, Ahmed Eldefrawy, Kristell Acosta, Bruce Kava, Murugesan Manoharan

Research output: Contribution to journalArticle

190 Citations (Scopus)

Abstract

Background: With the advent of prostate-specific antigen (PSA) screening and the increase in the number of transrectal ultrasound-guided biopsy cores, there has been a dramatic rise in the incidence of low-risk prostate cancer (LRPC). Because >97% of men with LRPC are likely to die of something other than prostate cancer, it is critical that patients give thought to whether early curative treatment is the only option at diagnosis. Objective: To identify a group of men with LRPC who may not require initial treatment and monitor them on our active surveillance (AS) protocol, to determine the percentage treated and the outcome and to analyze the quality-of-life data. Design, setting, and participants: We defined patients eligible for AS as Gleason ≤6, PSA ≤10, and two or fewer biopsy cores with ≤20% tumor in each core. Measurements: Kaplan Meier analysis was used to predict the 5-year treatment free survival. Logistic regression determined the predictors of treatment. Data on sexual function, continence, and outcome were obtained and analyzed. Results and limitations: The AS cohort consisted of 230 patients with a mean age of 63.4 yr; 86% remained on AS for a mean follow-up of 44 mo. Thirty-two of the 230 patients (14%) were treated for a mean follow-up of 33 mo. Twelve had a total prostatectomy (TP). The pathologic stage of these patients was similar to initially treated TP patients with LRPC. Fourteen underwent radiation therapy, and six underwent androgen-deprivation therapy. Fifty percent of patients had no tumor on the first rebiopsy, and only 5% of these patients were subsequently treated. PSA doubling time and clinical stage were not predictors of treatment. No patient progressed after treatment. Among the AS patients, 30% had incontinence, yet <15% were bothered by it. As measured by the Sexual Health Inventory for Men, 49% of patients had, at a minimum, moderate (≤16) erectile dysfunction. Conclusions: If guidelines for AS are narrowly defined to include only patients with Gleason 6, tumor volume ≤20% in one or two biopsy cores, and PSA levels ≤10, few patients are likely to require treatment. Progression-free survival of those treated is likely to be equivalent to patients with similar clinical findings treated at diagnosis.

Original languageEnglish
Pages (from-to)831-835
Number of pages5
JournalEuropean Urology
Volume58
Issue number6
DOIs
StatePublished - Dec 1 2010

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Prostatic Neoplasms
Prostate-Specific Antigen
Therapeutics
Prostatectomy
Biopsy
Reproductive Health
Kaplan-Meier Estimate
Erectile Dysfunction
Tumor Burden
Androgens
Disease-Free Survival
Neoplasms
Radiotherapy
Logistic Models
Quality of Life
Guidelines
Equipment and Supplies
Survival

Keywords

  • Active surveillance
  • Prostate cancer
  • Sexual function

ASJC Scopus subject areas

  • Urology

Cite this

Careful selection and close monitoring of low-risk prostate cancer patients on active surveillance minimizes the need for treatment. / Soloway, Mark S.; Soloway, Cynthia T.; Eldefrawy, Ahmed; Acosta, Kristell; Kava, Bruce; Manoharan, Murugesan.

In: European Urology, Vol. 58, No. 6, 01.12.2010, p. 831-835.

Research output: Contribution to journalArticle

Soloway, Mark S. ; Soloway, Cynthia T. ; Eldefrawy, Ahmed ; Acosta, Kristell ; Kava, Bruce ; Manoharan, Murugesan. / Careful selection and close monitoring of low-risk prostate cancer patients on active surveillance minimizes the need for treatment. In: European Urology. 2010 ; Vol. 58, No. 6. pp. 831-835.
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N2 - Background: With the advent of prostate-specific antigen (PSA) screening and the increase in the number of transrectal ultrasound-guided biopsy cores, there has been a dramatic rise in the incidence of low-risk prostate cancer (LRPC). Because >97% of men with LRPC are likely to die of something other than prostate cancer, it is critical that patients give thought to whether early curative treatment is the only option at diagnosis. Objective: To identify a group of men with LRPC who may not require initial treatment and monitor them on our active surveillance (AS) protocol, to determine the percentage treated and the outcome and to analyze the quality-of-life data. Design, setting, and participants: We defined patients eligible for AS as Gleason ≤6, PSA ≤10, and two or fewer biopsy cores with ≤20% tumor in each core. Measurements: Kaplan Meier analysis was used to predict the 5-year treatment free survival. Logistic regression determined the predictors of treatment. Data on sexual function, continence, and outcome were obtained and analyzed. Results and limitations: The AS cohort consisted of 230 patients with a mean age of 63.4 yr; 86% remained on AS for a mean follow-up of 44 mo. Thirty-two of the 230 patients (14%) were treated for a mean follow-up of 33 mo. Twelve had a total prostatectomy (TP). The pathologic stage of these patients was similar to initially treated TP patients with LRPC. Fourteen underwent radiation therapy, and six underwent androgen-deprivation therapy. Fifty percent of patients had no tumor on the first rebiopsy, and only 5% of these patients were subsequently treated. PSA doubling time and clinical stage were not predictors of treatment. No patient progressed after treatment. Among the AS patients, 30% had incontinence, yet <15% were bothered by it. As measured by the Sexual Health Inventory for Men, 49% of patients had, at a minimum, moderate (≤16) erectile dysfunction. Conclusions: If guidelines for AS are narrowly defined to include only patients with Gleason 6, tumor volume ≤20% in one or two biopsy cores, and PSA levels ≤10, few patients are likely to require treatment. Progression-free survival of those treated is likely to be equivalent to patients with similar clinical findings treated at diagnosis.

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