AUA 2011 - SBUR/SUO: Natural history of prostate cancer and its implications for over- and under-treatment - Session Highlights

WASHINGTON, DC USA (UroToday.com) - Dr. Peter Albertsen discussed the natural history of prostate cancer in the context of over- and under-treatment.

He commenced with a brief time-line: In 1930, Dr. Benjamin S. Barringer has written that prostate cancer in his era was primarily treated in a palliative fashion. Dr. Hugh Hampton Young promoted early detection of prostate cancer and use of radical prostatectomy. The Gleason scoring system was a major development, allowing doctors to sort out the aggressive vs. indolent tumors. PSA screening further enhanced and promoted the early detection of prostate cancer.

Dr. Albertsen studied the natural progression of prostate cancer and correlated this to patient age, PSA and Gleason score. Young men with aggressive tumors might well die from the disease, but older patients with less aggressive tumors were not likely to dieof CaP. The ERSPC trial showed that PSA screening benefited survival, although the effect is modest. The screening was performed every 4 years, while in the Gothenburg trial, screening was done every 2 years and the 10-year cumulative incidence of CaP is 13% compared with 8 % in the ERSPC trial. In the US, we screen annually, which suggests that we are over diagnosing indolent disease. The Gleason scoring system has also shifted, to eliminate grades 1 and 2 with a shift to higher grades from lower grades. If this is applied to the natural progression and modern contemporary survival curves, men with moderately differentiated disease are still unlikely to die of CaP. However, those with high-risk disease are relatively likely to die from CaP. Two or more comorbidities make it more likely to die of something other than CaP, while healthy young men with higher Gleason score tumors and long life expectancy may well die from CaP. In the SEER database, the more frequently PSA is screened, the more likely it is to diagnose CaP. The Bill-Axelson study showed that men treated with radical prostatectomy vs. watchful waiting, in an unscreened population, benefited from surgery if they were <65 years of age. He concluded that PSA screening lowers CaP mortality in a modest percentage of men under age 70. Many men with low risk disease are over-treated and many with high-risk disease are in need of better therapies.

 

 

Presented by Peter Albertsen, MD at the Society for Basic Urologic Research (SBUR)/Society of Urologic Oncology (SUO) joint meeting during the American Urological Association (AUA) Annual Meeting - May 14 - 19, 2011 - Walter E. Washington Convention Center, Washington, DC USA


Reported for UroToday by Christopher P. Evans, MD, FACS , Professor and Chairman, Department of Urology, University of California, Davis, School of Medicine.


 

The opinions expressed in this article are those of the UroToday.com Contributing Editor and do not necessarily reflect the viewpoints of the SPU or the American Urological Association.


 

 



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