Two things about Active Surveillance and Prostate Cancer


if you always tell the truth, you won't need a good memory...M. Twain
  • Most low and intermediate risk prostate cancers don’t progress-Do you know what low vs. intermediate risk means?
  • And…if they do there is “usually” no consequence to the delay in treatment

One caveat…”in most cases.” It takes a special mindset to choose surveillance and one must accept a small amount of risk that accompanies this choice.

© 2010 by American Society of Clinical Oncology

Outcomes of Active Surveillance for Men With Intermediate-Risk Prostate Cancer

  1. Matthew R. Cooperberg,
  2. Janet E. Cowan,
  3. Joan F. Hilton,
  4. Adam C. Reese,
  5. Harras B. Zaid,
  6. Sima P. Porten,
  7. Katsuto Shinohara,
  8. Maxwell V. Meng,
  9. Kirsten L. Greene and
  10. Peter R. Carroll

+ Author Affiliations


  1. From the University of California, San Francisco, Helen Diller Family Comprehensive Cancer Center, San Francisco, CA.
  • Corresponding author: Peter R. Carroll, MD, MPH, 1600 Divisadero, Box 1695, San Francisco, CA 94143-1695; e-mail: pcarroll@urology.ucsf.edu.
  • Abstract

    Purpose Active surveillance (AS) is an option for the initial management of early-stage prostate cancer. Current risk stratification schema identify patients with low-risk disease who are presumed to be most suitable for AS. However, some men with higher risk disease also elect AS; outcomes for such men have not been widely reported.

    Patients and Methods Men managed with AS at University of California, San Francisco, were classified as low- or intermediate-risk based on serum prostate-specific antigen (PSA), Gleason grade, extent of biopsy involvement, and T stage. Clinical and demographic characteristics, and progression in terms of Gleason score, PSA kinetics, and active treatment were compared between men with low- and intermediate-risk tumors.

    Results Compared to men with low-risk tumors, those with intermediate-risk tumors were older (mean, 64.9 v 62.3 years) with higher mean PSA values (10.9 v 5.1 ng/mL), and more tumor involvement (mean, 20.4% v 15.3% positive biopsy cores; all P < .01). Within 4 years of the first positive biopsy, the clinical risk group did not differ in terms of the proportions experiencing progression-free survival, (low [54%] v intermediate [61%]; log-rank P = .22) or the proportions who underwent active treatment (low [30%] v intermediate [35%]; log-rank P = .88). Among men undergoing surgery, none were node positive and none had biochemical recurrence within 3 years.

    Conclusion Selected men with intermediate-risk features be appropriate candidates for AS, and are not necessarily more likely to progress. AS for these men may provide an opportunity to further reduce overtreatment of disease that is unlikely to progress to advanced cancer.

    Footnotes

    • Supported by University of California-San Francisco Special Program of Research Excellence Grant No. P50CA89520 from the National Institutes of Health/National Cancer Institute.

    • Authors’ disclosures of potential conflicts of interest and author contributions are found at the end of this article.

  • Received July 2, 2010.
  • Accepted October 7, 2010.
  • 2 Replies to “Two things about Active Surveillance and Prostate Cancer”

    1. Good news at last we have some health care professionals saying what we men with prostate cancer have been saying for a few years. Its not ‘rocket science’ just good health care management.

      “Overtreatment could be cut drastically if we took time to assess each patients risk factors.”

      As a UK patient with metastaic prostate cancer (PCa) I have often wondered if the reasons why so few men opt for AS (Active Surveillance) were some or all of the following.

      1/ AS requires careful monitoring of patients (more specialist nurses would be no bad thing).

      2/ If men are offered a 90+% chance of a possible cure with surgery or RT (radiotherapy) they are unlikely to opt for AS unless it is explained to them in fine detail.

      3/ If the consultant specialised in either surgery or RT they may have a vested interest in treating rather than offering AS.
      Without these patients to treat they have a lighter workload and hence a lower profile.

      Two other areas I would like to see addressed in the UK are:-

      1/ The identification of those men in the ‘high risk’ groups (we all know who they are) and offer them testing (screening) at an early stage and then monitor them closely for any signs of the disease progressing and before it passes through that window of opportunity of a possible cure.

      2/ Research into prostate cancer to be better controlled so that the money available for research goes to those trials etc that show some light at the end of the tunnel rather than to the researchers who have the best PR team and who make no real difference other than satisfying a few egos and perhaps gaining accolades for the research head.

      3/ Closer working realationships between patients, primary care and consultants. Which where possible should be patient led. “NO DECISION ABOUT ME WITHOUT ME”

      Like

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