Active surveillance followed by selective treatment for men who have evidence of disease progression may be an option for some patients with early-stage prostate cancer.
Peter Carroll and a team at UCSF report the experience of a group of men men with prostate cancer who were managed with active surveillance.
All men treated for prostate cancer at UCSF who were advised to pursue active surveillance as the first step in managing the condition were tagged in the database. Selection criteria for active surveillance included:
prostate-specific antigen (PSA)<10 ng/mL
biopsy Gleason sum 6 or lower with no pattern 4 or 5
cancer involvement of < (less than) 33% of biopsy cores
clinical stage T1/T2a tumor.
Patients were followed with PSA measurements and digital rectal examination every 3 to 6 months and with transrectal ultrasound at 6- to 12-month intervals. Beginning in 2003, patients also underwent repeat prostate biopsy at 12 to 24 months.
This study looked to see how many of these men went on to need and receive active treatment. stage
The study also measured specific evidence of disease progression in this group of men. Evidence of disease progression was defined as
an increase in rebiopsy Gleason sum
or significant PSA velocity changes (>0.75 ng/mL per year).
Analysis showed that 321 men (mean age 63.4+/-8.5 years) selected active surveillance as their initial management. The overall median follow-up was 3.6 years, with a quite enormous range from one to 17 years.
The initial mean PSA level was 6.5+/-3.9 ng/mL. One hundred twenty men (37%) met at least 1 criterion for progression. Overall, 38% of men had higher grade on repeat biopsy, and 26% of men had a PSA velocity>0.75 ng/mL per year.
Seventy-eight men (24%) received secondary treatment at a median 3 years (range, 1-17 years) after diagnosis. Approximately 13% of patients with no disease progression elected to obtain treatment.
PSA density at diagnosis and rise in Gleason score on repeat biopsy were associated significantly with receipt of secondary treatment. The disease-specific survival rate was 100%.
The authors believe that active surveillance suits some prostate cancer patients' situations, with the emphasis on both "active" and "surveillance." This is far more than a form of passive waiting.
"Selected individuals with early-stage prostate cancer may be candidates for active surveillance," they conclude. "Specific criteria can be and need to be developed to select the most appropriate individuals for this form of management and to monitor disease progression. A small attrition rate can be expected because of men who are unable or unwilling to tolerate surveillance."
Original Article
Active surveillance for the management of prostate cancer in a contemporary cohort
Cancer. 2008 Jun 15;112(12):2664-70.
Treatments - Active Surveillance