221 OUTCOMES FOLLOWING ACTIVE SURVEILLANCE IN PROSTATE CANCER PATIENTS WITH A PSA >10

Abstract

You have accessJournal of UrologyProstate Cancer: Epidemiology & Natural History (I)1 Apr 2013221 OUTCOMES FOLLOWING ACTIVE SURVEILLANCE IN PROSTATE CANCER PATIENTS WITH A PSA >10 Paul Toren, Lih-Ming Wong, Narhari Timilshina, and Antonio Finelli Paul TorenPaul Toren Toronto, Canada More articles by this author , Lih-Ming WongLih-Ming Wong Toronto, Canada More articles by this author , Narhari TimilshinaNarhari Timilshina Toronto, Canada More articles by this author , and Antonio FinelliAntonio Finelli Toronto, Canada More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2013.02.1601AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES The use of prostate specific antigen (PSA) in active surveillance (AS) for prostate cancer is controversial. In some cases an elevated PSA is used as reason against surveillance, though some evidence suggests that it is a very unreliable marker. In this study we review our experience in patients with a PSA over 10ng/mL who continued on surveillance. METHODS Our cohort included all patients on AS with clinical stage T1c-T2a, Gleason score ≤6, and three or fewer cores positive with no more than 50% of a core involved at initial diagnostic biopsy. Patients with less than two biopsies were excluded. Patients were grouped into those who 1) started AS with a PSA >10ng/mL, 2) had a PSA rise >10ng/mL during follow-up and 3) had a PSA<10ng/mL throughout AS. Pathologic progression (PP) was defined as biopsy parameters exceeding the entry criteria limits. RESULTS There were 697 patients in our cohort according to biopsy criteria. They had a mean age of 64.1 years at diagnosis and a median follow-up of 46.2 months (IQR 29.6-66.6). Table 1 shows baseline characteristics for each group. Selection of patients was seen with fewer patients with positive family history, higher age and prostate volume among those with an elevated PSA as well as differential rates of treatment. Table 2 shows outcomes on AS by group. The proportion of the 103 patients who had a radical prostectomy (RP) as treatment was not different between groups (P=0.46). Gleason scores at RP were similar between groups except that there were more patients with a PSA rise to over 10ng/mL with a Gleason ≥ 8 score (5 vs 0 in group with baseline PSA ≥ 10 vs 3 patients in group with PSA <10, p=0.002). In our cohort those starting AS with a PSA >10ng/mL did not have a higher rate of pathologic progression at first or subsequent repeat biopsy compared to those following stricter criteria. CONCLUSIONS With careful selection, prostate cancer patients with a PSA >10ng/mL may be put on active surveillance. Further follow-up is needed to validate these results with more definitive endpoints. Table 1. Baseline characteristics of patients on active surveillance by group Baseline PSA ≥10 (n=83) PSA rises ≥10 (n=156) PSA <10 (n=458) P-value Mean Age (SD) 65.6 (6.0) 64.9 (7.2) 63.4 (7.5) 0.011 Median PSA, ng/mL (IQR) 12.4 (10.7-14.9) 6.7 (4.8-8.2) 4.7 (3.2-6.1) 0.0001 Median PSAD, ng/mL2 (IQR) 0.18 (0.14-0.27) 0.12 (0.09-0.18) 0.09 (0.07-0.14) 0.0001 Median Prostate Volume, mL (IQR) 64 (50-93) 47.5 (36-62) 42 (33-59) 0.0001 Family History Yes 7 (8.5) 30 (19.4) 107 (23.6) 0.03 No 45 (54.9) 82 (52.9) 214 (47.2) Unknown 30 (36.6) 43 (27.7) 132 (29.1) Biopsy cores positive (%) 1 60 (72.3) 113 (72.4) 318 (69.4) 0.75 2 19 (22.9) 33 (21.2) 101 (22.1) 3 4 (4.8) 10 (6.4) 39 (8.5) Maximum% core involvement 6.0 (1-50) 7.1 (1-50) 6.0 (1-50) 0.56 SD = standard deviation; IQR = interquartile range; PSA = prostate specific antigen; PSAD = PSA density; Table 2. Outcomes of active surveillance by group Baseline PSA ≥10 (n=83) PSA rises >10 (n=156) PSA <10 (n=458) P-value Median follow-up months (IQR) 33.8 (20.4-59.1) 53.9 (34.8-74.3) 36.3 (19.4-62.2) 0.001 Median months to 1st repeat biopsy (IQR) 13.7 (6.6-24.1) 15.2 (7.6-28.4) 12.3 (6.1-20.1) 0.002 PP at 1st repeated biopsy(%) 18 (21.7) 43 (27.6) 102 (22.3) 0.37 Reason for PP Number of cores involved (%) 9 (10.8) 29 (18.6) 62 (13.5) 0.18 Gleason score (%) 12 (14.5) 33 (21.2) 70 (15.3) 0.20 core involvement (%) 4 (4.8) 16 (10.3) 30 (6.6) 0.20 PP at subsequent biopsy (%) 9 (13.9) 26 (23.0) 68 (19.1) 0.32 Number started on 5-ARI (%) 16 (19.3) 29 (18.6) 80 (17.5) 0.89 Number who underwent treatment (%) 32 (38.5) 61 (39.1) 135 (29.5) 0.04 IQR= interquartile range; PSA= prostate specific antigen; PP= pathologic progression; 5-ARI= 5-alpha reductase inhibitor © 2013 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 189Issue 4SApril 2013Page: e91-e92 Advertisement Copyright & Permissions© 2013 by American Urological Association Education and Research, Inc.MetricsAuthor Information Paul Toren Toronto, Canada More articles by this author Lih-Ming Wong Toronto, Canada More articles by this author Narhari Timilshina Toronto, Canada More articles by this author Antonio Finelli Toronto, Canada More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...