INTRODUCTION: The use of prostate-specific antigen (PSA) in active surveillance (AS) for prostate cancer is controversial.
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Some consider it an unreliable marker and others as sufficient evidence to exclude patients from AS. We analyzed our cohort of AS patients with a PSA over 10 ng/mL.
METHODS: We included patients who had clinical T1c-T2a Gleason ≤ 6 disease, and ≤ 3 positive cores with ≤ 50% core involvement at diagnostic biopsy and ≥2 total biopsies. Patients were divided into 3 groups: (1) those with baseline PSA >10 ng/mL, (2) those with a PSA rise >10 ng/mL during follow-up; and (3) those with a PSA < 10 ng/mL throughout AS. Adverse histology was defined as biopsy parameters exceeding the entry criteria limits. We further compared this cohort to a concurrent institutional cohort with equal biopsy parameters treated with immediate radical prostatectomy.
RESULTS: Our cohort included 698 patients with a median follow-up of 46.2 months. In total, 82 patients had a baseline PSA >10 ng/mL and 157 had a PSA rise >10 ng/mL during surveillance. No difference in adverse histology incidence was detected between groups (p = 0.3). Patients with a PSA greater than 10 were older and had higher prostate volumes. Hazard ratios for groups with a PSA >10 were protective against adverse histology. Larger prostate volume and minimal core involvement appear as factors related to this successful selection of patients to be treated with AS.
CONCLUSION: These results suggest that a strict cut-off PSA value for all AS patients is unwarranted and may result in overtreatment. Though lacking long-term data and validation, AS appears safe in select patients with a PSA >10 ng/mL and low volume Gleason 6 disease.
Toren P, Wong LM, Timilshina N, Alibhai S, Trachtenberg J, Fleshner N, Finelli A. Are you the author?
Department of Urologic Sciences, University of British Columbia, Vancouver, BC; Department of Urology, St. Vincent's Hospital and Austin Health, University of Melbourne, Victoria, Australia; Department of Surgery (Urology), University of Toronto, Princess Margaret Hospital, Toronto, ON; Department of Medicine and Institute of Health Policy, Management, and Evaluation, University Health Network and University of Toronto, Toronto, ON.
Reference: Can Urol Assoc J. 2014 Sep;8(9-10):E702-7.