OBJECTIVES: Outcome data from a prospective study of active surveillance of localised prostate cancer were analysed to identify factors, present at the time of diagnosis, that predict subsequent radical treatment. METHODS: Eligible patients had clinical stage T1-T2a, N0-Nx, M0-Mx adenocarcinoma of the prostate with serum PSA<15 ng/ml, Gleason score <or= 7, primary Gleason grade <or= 3, and % positive biopsy cores (pbc) <or= 50%. Monitoring included serial PSA measurement and repeat prostate biopsies. Radical treatment was initiated in the event of biochemical progression (PSA velocity > 1 ng/ml/yr) or histological progression (primary Gleason grade >or= 4, or %pbc > 50%). Multivariate Cox regression analysis of baseline variables was performed with respect to time to radical treatment. RESULTS: The 326 men recruited from 2002 to 2006 have been followed for a median of 22 mo. Median age was 67 yr, and median initial PSA (iPSA) 6.4 ng/ml. Sixty-five patients (20%) had deferred radical treatment, 16 (5%) changed to watchful waiting because of increasing comorbidity, 7 (2%) died of other causes, and 238 (73%) remain on surveillance. On multivariate Cox regression analysis, the free/total PSA ratio (p<0.001) and clinical T stage (p=0.006) were independent determinants of time to radical treatment. CONCLUSIONS: In addition to established prognostic factors, the free/total PSA ratio may predict time to radical treatment in patients with untreated, localised prostate cancer managed by active surveillance. This possibility warrants further study.
OBJECTIVES: Outcome data from a prospective study of active surveillance of localised prostate cancer were analysed to identify factors, present at the time of diagnosis, that predict subsequent radical treatment. METHODS: Eligible patients had clinical stage T1-T2a, N0-Nx, M0-Mx adenocarcinoma of the prostate with serum PSA<15 ng/ml, Gleason score <or= 7, primary Gleason grade <or= 3, and % positive biopsy cores (pbc) <or= 50%. Monitoring included serial PSA measurement and repeat prostate biopsies. Radical treatment was initiated in the event of biochemical progression (PSA velocity > 1 ng/ml/yr) or histological progression (primary Gleason grade >or= 4, or %pbc > 50%). Multivariate Cox regression analysis of baseline variables was performed with respect to time to radical treatment. RESULTS: The 326 men recruited from 2002 to 2006 have been followed for a median of 22 mo. Median age was 67 yr, and median initial PSA (iPSA) 6.4 ng/ml. Sixty-five patients (20%) had deferred radical treatment, 16 (5%) changed to watchful waiting because of increasing comorbidity, 7 (2%) died of other causes, and 238 (73%) remain on surveillance. On multivariate Cox regression analysis, the free/total PSA ratio (p<0.001) and clinical T stage (p=0.006) were independent determinants of time to radical treatment. CONCLUSIONS: In addition to established prognostic factors, the free/total PSA ratio may predict time to radical treatment in patients with untreated, localised prostate cancer managed by active surveillance. This possibility warrants further study.
Authors: Trevor A Flood; Nicola Schieda; Daniel T Keefe; Rodney H Breau; Chris Morash; Kevin Hogan; Eric C Belanger; Kien T Mai; Susan J Robertson Journal: Virchows Arch Date: 2016-07-10 Impact factor: 4.064
Authors: Stacy Loeb; Sophie M Bruinsma; Joseph Nicholson; Alberto Briganti; Tom Pickles; Yoshiyuki Kakehi; Sigrid V Carlsson; Monique J Roobol Journal: Eur Urol Date: 2014-10-31 Impact factor: 20.096
Authors: Scott E Eggener; Alex Mueller; Ryan K Berglund; Raj Ayyathurai; Cindy Soloway; Mark S Soloway; Robert Abouassaly; Eric A Klein; Steven J Jones; Chris Zappavigna; Larry Goldenberg; Peter T Scardino; James A Eastham; Bertrand Guillonneau Journal: J Urol Date: 2009-02-23 Impact factor: 7.450
Authors: L M Wong; S Ferrara; S M H Alibhai; A Evans; T Van der Kwast; G Trottier; N Timilshina; A Toi; G Kulkarni; R Hamilton; A Zlotta; N Fleshner; A Finelli Journal: Prostate Cancer Prostatic Dis Date: 2014-12-09 Impact factor: 5.554
Authors: John W Davis; Jeri Kim; John F Ward; Xuemai Wang; Hiro Nakanishi; R Joseph Babaian; Patricia Troncoso Journal: BJU Int Date: 2009-11-03 Impact factor: 5.588