SURVEILLANCE FEASIBLE FOR LOW RISK PROSTATE CANCER PATIENTS

Active Surveillance Safe for Men With Low-Risk Prostate Cancer

NEW YORK (Reuters Health) Mar 31 - For selected patients with prostate cancer, active surveillance appears to be safe and is associated with a low risk of systemic progression, researchers report in the April issue of The Journal of Urology.

Despite the potential survival advantages associated with therapy, senior investigator Dr. Bertrand Guillonneau told Reuters Health, "there is still a large number of patients who are over-treated and who will suffer from prolonged side effects that impair their quality of life."

To study the safety of active monitoring of men with low-risk prostate cancer, Dr. Guillonneau of Memorial Sloan-Kettering Cancer Center, New York, and colleagues studied 268 men younger than 75 years old who had been given multiple treatment options but ultimately chose active surveillance.

They had a prostate specific antigen (PSA) level no higher than 10 ng/mL, clinical stage T1-T2a disease, a Gleason score of 6 or lower, and no more than 3 positive cores at diagnostic biopsy.

The subjects had a restaging biopsy immediately before active surveillance began and no treatment in the following 6 months.

Over a median follow-up of 29 months, 43 patients received treatment; 41 of them have no disease progression at a median of 23 months following treatment.

At 2 years the probability of staying on active surveillance was 91%. At 5 years, it was 75%.

Patients with cancer on the second biopsy and a higher total number of cancerous cores were significantly more likely to undergo treatment. Other factors, including age, PSA and clinical stage, were not associated with outcome.

"Active surveillance, based on strict criteria based on repeat prostate biopsy," continued Dr. Guillonneau, "might be a way to sort out patients with growing tumor that requires treatment from quiescent tumor that will not progress."

"Our study indicates that 75% of the patients who are real candidates for active surveillance will still fulfill the same criteria 5 years later, demonstrating the absence of noticeable progression."

"These patients should still be closely monitored," he concluded, "but it seems likely, for many of them, the prostate cancer will not ultimately develop and will not require any kind of active and therefore morbid treatment."