STOCKHOLM, SWEDEN (UroToday.com) - Dr. J. J. Aning presented an abstract on a cohort of 853 men (mean age of 65 years) with low- and intermediate-risk prostate cancer from Vancouver, Canada who were managed by active surveillance (AS). The primary aim of their study was to identify risk factors which lead to progression of prostate cancer while under AS. All men were 75-years-old or younger and had undergone restaging prostate biopsy, with at least 6 months of follow up. Their AS protocol involved 6 monthly PSA and DRE reviews in addition to rebiopsy of the prostate, with planned repeat biopsies every 2 years. Prostate cancer risk status was defined by National Comprehensive Cancer Network guideline criteria.
Mean PSA at diagnosis was 6.5ng/ml, with mean follow up of 5 years. Of the cohort, 50%, 27% and 23% were classified as very low-, low-, or intermediate-risk prostate cancer, respectively. Three hundred-nine men progressed to active treatment, most commonly due to grade progression at re-biopsy (62%), followed by patient choice (10%), and PSA progression (8%). Dr. Aning and colleagues reported actuarial probability of remaining on AS at 1, 2, 5, 8 years: 95%, 81%, 60%, and 47%, respectively. They reported a significant difference in the risk of progression to treatment between very low risk and other groups (p = 0.002), but not between low and intermediate risk groups (p= 0.481). On multivariate analysis, they determined that increasing number of positive biopsy cores at diagnosis and PSA density were significant predictors of progression to treatment (p= < 0.001). Negative prostate biopsy prior to diagnosis was found to be a significant negative predictor of progression to treatment (p=0.01). Of those treated, 4% (n=15) had biochemical recurrence. Overall survival of their AS cohort was 97%, with 1 death due to prostate cancer. Institutions continue to show evidence that AS is certainly a safe and viable option in select cohorts of men with diagnosis of prostate cancer.
Presented by J. J. Aning at the 29th Annual European Association of Urology (EAU) Congress - April 11 - 15, 2014 - Stockholmsmässan - Stockholm, Sweden
Vancouver Prostate Centre, Vancouver, Canada
Written by Reza Mehrazin, MD, medical writer for UroToday.com