Predicting the probability of deferred radical treatment for localised prostate cancer managed by active surveillance.

Abstract:

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 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.

journal_name

Eur Urol

journal_title

European urology

authors

van As NJ,Norman AR,Thomas K,Khoo VS,Thompson A,Huddart RA,Horwich A,Dearnaley DP,Parker CC

doi

10.1016/j.eururo.2008.02.039

subject

Has Abstract

pub_date

2008-12-01 00:00:00

pages

1297-305

issue

6

eissn

0302-2838

issn

1873-7560

pii

S0302-2838(08)00272-8

journal_volume

54

pub_type

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