The two things:
- 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
- Matthew R. Cooperberg,
- Janet E. Cowan,
- Joan F. Hilton,
- Adam C. Reese,
- Harras B. Zaid,
- Sima P. Porten,
- Katsuto Shinohara,
- Maxwell V. Meng,
- Kirsten L. Greene and
- Peter R. Carroll
+ Author Affiliations
From the University of California, San Francisco, Helen Diller Family Comprehensive Cancer Center, San Francisco, CA.
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.
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.