Urologists analyzing data from prostate cancer patients suggest wait and watch in well-informed low-risk prostate cancer patients.
With the objective of identifying the proportion of men diagnosed with prostate cancer who could be actively followed rather than treated, researchers at the University of Texas Health Science Center followed 281 patients who developed the disease between 2000 and 2012. Published in the Journal of Urology, the authors conclude that their results suggest two-thirds of men diagnosed with prostate cancer qualify for active surveillance.
Of the nearly 4000 men enrolled in the SABOR study at the University of Texas, 320 were diagnosed with prostate cancer, of whom 281 were eligible for participation based on data availability. The 281 patients were reviewed based on the following 2 criteria:
Criteria 1: prostate specific antigen density less than 15%, 2 or fewer cores involved with cancer, Gleason score less than or equal to 6, and cancer involving 50% or less of biopsy volume.
Criteria 2: 4 or less fewer cores with Gleason 3 + 3 cancer and only 1 core of Gleason 3 + 4 cancer with up to 15% of core involved with Gleason 3 + 4 disease.
Up staging and upgrading was a consideration in those undergoing radical prostatectomy.
The authors write that of the 281 patients, 187 or 67% were eligible for active surveillance under either criteria. They had access to treatment data for 178 patients, of whom 74 underwent radical prostatectomy. Based on the initial biopsy, 14 men (33%) who met criteria 1 and 9 (25%) who met criteria 2 were upgraded or staged on final pathological review, while 38% of those who did not meet either criteria were upgraded and/or up staged, the authors state.
The authors explain that previous reports of active surveillance may have introduced bias, since they were provided either by patients who were treated at clinics or from tumors analyzed at urology centers. They propose that based on the results of their study, active surveillance should be offered to the expanded population after explaining to patients, who have the lowest risk of disease progression, the risk-benefit of disease progression versus preserving organ function.