124 OUTCOMES OF MEN DIAGNOSED WITH SCREEN-DETECTED PROSTATE CANCER INITIALLY WITHHOLDING RADICAL TREATMENT

Abstract

You have accessJournal of UrologyProstate Cancer: Epidemiology and Natural History I1 Apr 2010124 OUTCOMES OF MEN DIAGNOSED WITH SCREEN-DETECTED PROSTATE CANCER INITIALLY WITHHOLDING RADICAL TREATMENT Roderick van den Bergh, Pim van Leeuwen, Tineke Wolters, Chris Bangma, Monique Roobol, and Fritz Schröder Roderick van den BerghRoderick van den Bergh More articles by this author , Pim van LeeuwenPim van Leeuwen More articles by this author , Tineke WoltersTineke Wolters More articles by this author , Chris BangmaChris Bangma More articles by this author , Monique RoobolMonique Roobol More articles by this author , and Fritz SchröderFritz Schröder More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2010.02.175AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Information on the outcomes of patients with expectantly managed prostate cancer (PC) is increasingly important in an era where a proportion of PCs might be overdiagnosed and do not need radical treatment. We assessed the outcomes of men with screen-detected PC who primarily embarked on a strategy of expectant management. METHODS All patients underwent screening for PC in the Rotterdam section of the European Randomized Study of Screening for Prostate Cancer (ERSPC), were diagnosed with PC, and initially elected expectant management. Patients with adverse disease (T stage >=3, PSA >=20.0 ng/ml, Gleason >7) were excluded. No fixed protocol for diagnostics during expectant management or switching to deferred radical therapy was applied. We provide an update of the active therapy-free, metastases-free, overall, and PC-specific survival, and last known PSA values. RESULTS Our study cohort consisted of 464 patients, median (25-75p) follow-up 4.5 (1.7-8.2) years after diagnosis (T1: 81%, T2: 19%; Gleason 6: 94%, <6: 6%; median PSA 3.6 (3.0-4.7) ng/ml. The 12-year (21 men at risk) active therapy-free survival was 62%. Radical treatment was delayed in 110 men (24 received deferred prostatectomy, 70 radiation therapy, 16 other) for 1.7 (0.9-3.7) years and avoided so far in 354 men for 3.8 (1.5-7.5) years. Men with more favorable disease remained untreated longer. The 12-year overall and PC-specific survival rates were 70% and 99% respectively. A total of 51 men died due to any cause after 4.9 (3.2-8.3) years. Two men died due to PC: 1 man died 0.5 years after diagnosis during treatment of an abdominal aneurysm that was coincidentally found at dissemination studies of PC, in 1 man (T2a, PSA 3.1, volume 39cc, 2/6 positive biopsies) the window of curability was potentially missed due to the initial expectant management. PSA was 8.8 ng/ml 2 mo after diagnosis (evidence of capsular penetration was also found later), he received radiation therapy 0.8 year after diagnosis, but he died due to PC 5.8 years after diagnosis. No other patients developed metastases during follow-up. At the moment of analysis 23/361 still untreated men had a PSA >10 ng/ml. CONCLUSIONS Initially withholding radical treatment in screen-detected PC may delay or even avoid radical treatments and their side effects. Longer-term follow-up and data of trials randomizing for treatment are indispensable to conclude whether this strategy is associated with adverse outcomes; prospective protocol-based active surveillance studies to develop adequate follow-up protocols. Rotterdam, Netherlands© 2010 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 183Issue 4SApril 2010Page: e51 Advertisement Copyright & Permissions© 2010 by American Urological Association Education and Research, Inc.MetricsAuthor Information Roderick van den Bergh More articles by this author Pim van Leeuwen More articles by this author Tineke Wolters More articles by this author Chris Bangma More articles by this author Monique Roobol More articles by this author Fritz Schröder More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...