ORLANDO, FL, USA (UroToday.com) - In patients with localized prostate cancer, active surveillance (AS) is an accepted management strategy. In earlier mature study cohorts, the rate of pathological upgrading has not been well described, but in one study cohort from UCSF, 34% of the patients were upgraded.
This Toronto study looked at patients in a prospectively-collected AS database, and patients with at least one repeat biopsy were included. The goal was to look at the proportion of men upgraded (Gleason 6 to 3+4 or higher, Gleason 3+4 to 4+3 or higher) with time from diagnostic biopsy, in this cohort. The total number of patients included were 862, and 593 of them had at least one repeat biopsy during a median follow-up of 6.4 years (max 20.2 years). The majority of patients in the cohort were low risk (79.7%) and 20% were intermediate-risk patients. In this cohort, 31.2% of the patients were upgraded during AS. The proportion of patients upgraded increased with time, and the estimated rate of increase was higher in patients with intermediate-risk disease at diagnosis compared to patients with low- risk disease. Of the upgraded patients, 62% started on active treatment. Compared to the patients who remained on AS, the patients who were upgraded and started treatment had significantly higher Gleason scores and PSA velocities than those who remained on AS.
Highlights of a presentation by Andrew Loblaw, MD, FRCPC, MSc at the 2013 Genitourinary Cancers Symposium - February 14 - 16, 2013 - Rosen Shingle Creek - Orlando, Florida USA
Sunnybrook Health Sciences Centre, Toronto, ON, Canada
Written by Anna Forsberg, medical reporter for UroToday.com
View Full 2013 GU Cancers Symposium Coverage