WASHINGTON, DC USA (UroToday.com) - May 16, 2011
Methods May Alleviate Uncertainties in Cases of Active Surveillance, “Watchful Waiting”
Prostate cancer can be a slow-growing, low-risk disease that prompts cases of active surveillance (AS) or “watchful waiting,” which may be anxiety-producing for the patient. But according to two new studies – one dealing with MRI and the other with extended sampling biopsies – may give new direction on how to manage cases of low-risk prostate cancers. The studies will be presented to the media during a special press conference on Monday, May 16, 2011 at 2 p.m. during the 106th Annual Scientific Meeting of the American Urological Association (AUA).
Men Selected For Repeat Biopsy After Initial Negative Biopsy Often Undergo Multiple Biopsies Prior to Cancer Diagnosis (#2127): Doctors are not certain about when to repeat a biopsy in men who have elevated PSA levels with initial negative biopsies, or when to perform extended sampling, in which more than one sample is taken from the prostate in a single procedure, according to new data from researchers at the New York University School of Medicine.
Researchers identified 1,213 men who had an initial negative biopsy. 803 repeat biopsies were performed on 274 men. 16 percent of the men had as many as five repeat biopsies. An increasing proportion of men were diagnosed with prostate cancer on repeat biopsies: 10 percent on the second; 10 percent on the third; 11 percent on the fourth and 27 percent on the fifth. More than 50 percent of repeat biopsies included more than 12 cores, and 25 percent of men undergoing repeat biopsy were found to have prostate cancer. Authors conclude that, given the continued likelihood of cancer detection by the fifth biopsy, early consideration of extended sampling biopsies might be warranted and could improve detection and prevent men from undergoing repeat procedures.
Prostate MRI Findings Prior To Commencing Active Surveillance Among Men With Low Risk Prostate Cancer (#1292): Failure to fully recognize the amount of disease at baseline may be cause for active surveillance (AS) failure, according to new data from researchers at Department of Surgical Oncology, Princess Margaret Hospital, University Health Network, Toronto, who found that magnetic resonance imaging (MRI) discovered large volume disease in up to 22 percent of patients with low-risk prostate cancer who are managed with active surveillance. The researchers concluded that MRI prior to AS should be strongly considered as part of standard patient care, and particularly among patients with elevated PSA density. Men were studied who had low-grade, low-risk localized prostate cancer. The study cohort was 60 patients. MRI did not detect any cancer in 23 patients (38 percent), while MRI and initial biopsy were consistent in 24 patients (40 percent).
However, MRI identified 13 patients (22 percent) with troubling discrepant findings (TDF). In 10 cases, a biopsy confirmed the presence of cancer. The average unidimensional size of these tumors was 1.5 cm and 50 percent of them had Gleason sum upgrading. Only PSA density was significantly elevated among those patients identified through MRI compared to those with no MRI-detected cancer.
“The slow growth of many prostate cancers is one of the most vexing areas that we deal with in treating this disease and knowing when active surveillance is the best solution,” said AUA spokesperson Joseph Presti, MD. “MRI and extended sampling biopsies may be a solution to this problem.”