PURPOSE: The purpose of this study was to determine the fraction of men who would qualify for active surveillance (AS) in a population-based cohort diagnosed with prostate cancer.
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Of those who qualified and subsequently underwent primary treatment with radical prostatectomy (RP), we assessed the rate of upgrading and upstaging.
METHODS: The San Antonio Center of Biomarkers of Risk for prostate cancer is a Clinical and Epidemiologic Center of the Early Detection Research Network (EDRN), National Cancer Institute, with 3,828 men enrolled at time of review. Of these, 320 men were diagnosed with prostate cancer; among which 281 had sufficient data for review. These 281 cases were reviewed to determine their suitability for AS using two sets of criteria. Criterion 1: PSA density < 15%, ≤ 2 cores involved with cancer, Gleason score ≤ 6, and cancer involving ≤ 50% of biopsy volume. Criterion 2: ≤ 4 cores with Gleason 3+3 cancer and only one core of Gleason 3+4 cancer with up to 15% of core involved with Gleason 3+4 disease. For those undergoing RP, we examined rates of upstaging and upgrading.
RESULTS: Of the 281 patients, 187 (67%) qualified for AS under criterion #1 and/or criterion #2. Treatment data were available for 178 patients, and 74 underwent RP. Using the initial biopsy, 14 (33.1%) meeting criteria #1 and 9 (25%) meeting criteria #2 were either upgraded and/or upstaged on final pathologic review; by comparison, 38% of those who did not qualify for AS were either upgraded and/or upstaged.
CONCLUSIONS: In a population-based cohort, two-thirds of men diagnosed with prostate cancer qualify for active surveillance. Less restricted criteria for surveillance may be appropriate based on similar rates of upgrading/upstaging at RP.
Overholser S, Nielsen M, Torkko K, Cwilka D, Weaver B, Shi X, Leach RJ, Hernandez J, Huang T, Thompson IM Jr, Thompson IM 3rd. Are you the author?
Department of Urology, Cancer Therapy and Research Center, the University of Texas Health Science Center at San Antonio, San Antonio, Texas; School of Medicine, Cancer Therapy and Research Center, the University of Texas Health Science Center at San Antonio, San Antonio, Texas; Department of Pathology, University of Colorado Denver School of Medicine, Aurora, Colorado; Department of Molecular Medicine, the University of Texas Health Science Center at San Antonio, San Antonio, Texas.
Reference: J Urol. 2015 Jan 27. pii: S0022-5347(15)00179-2.