BERKELEY, CA (UroToday.com) - Active surveillance (AS) is increasingly the subject of prostate cancer (PCa) publications. Some report that a sizable share of new diagnoses of PCa can be managed conservatively. Many laboratories provide biomarker studies for PCa to assist urologists and patients with additional tools for making the decision to forego conservative (watchful waiting and even active surveillance) versus aggressive treatments (prostatectomy and radiation treatment).
This study brings up some very interesting data of one oncology reference center in Latin America. Among the 3 main tools to indicate active surveillance for a patient with PCa, we find the single positive-core PCa and Gleason ≤ 6 at biopsy. Some points in our study that are worth noting are that 172 patients (69.0%) had a pathological finding ≥ pT2c, 87 (34.9%) had an undergraded Gleason score at biopsy, 20.8% had positive surgical margins, 10.0% had extraprostatic extension and 6.0% had seminal vesicle invasion. Analyzing these results, we note that not all of these are indolent tumors. These characteristics suggest that single positive-core prostate cancer should be analyzed individually, should be discussed with the patient, and can be considered for treatment in the same manner as multiple positive core prostate cancer.
A newly published study in the New England Journal of Medicine (N Engl J Med. 2014 Mar 6;370(10):932-42) ratifies our findings. That study, with 23 years of follow-up (695 patients), compared watchful waiting or radical prostatectomy in patients with early prostate cancer. The primary end points were death from any cause, death from prostate cancer, and the risk of metastases. The number needed to treat to prevent one death was 8. So extended follow-up confirmed a substantial reduction in mortality after radical prostatectomy.
We know that the lack of a standardized pathological biopsy review is the main limitation of our study, but we affirm that it accurately reflects the routine of the patients in most centers in Brazil, and probably in the rest of the world.
Ricardo Kupka, MD as part of Beyond the Abstract on UroToday.com. This initiative offers a method of publishing for the professional urology community. Authors are given an opportunity to expand on the circumstances, limitations etc... of their research by referencing the published abstract.
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