TY - JOUR
T1 - Role of prostate specific antigen and immediate confirmatory biopsy in predicting progression during active surveillance for low risk prostate cancer
AU - Adamy, Ari
AU - Yee, David S.
AU - Matsushita, Kazuhito
AU - Maschino, Alexandra
AU - Cronin, Angel
AU - Vickers, Andrew
AU - Guillonneau, Bertrand
AU - Scardino, Peter T.
AU - Eastham, James A.
N1 - Funding Information:
Supported by the Sidney Kimmel Center for Prostate and Urologic Cancers .
PY - 2011/2
Y1 - 2011/2
N2 - Purpose We evaluated predictors of progression after starting active surveillance, especially the role of prostate specific antigen and immediate confirmatory prostate biopsy. Materials and Methods A total of 238 men with prostate cancer met active surveillance eligibility criteria and were analyzed for progression with time. Cox proportional hazards regression was used to evaluate predictors of progression. Progression was evaluated using 2 definitions, including no longer meeting 1) full and 2) modified criteria, excluding prostate specific antigen greater than 10 ng/ml as a criterion. Results Using full criteria 61 patients progressed during followup. The 2 and 5-year progression-free probability was 80% and 60%, respectively. With prostate specific antigen included in progression criteria prostate specific antigen at confirmatory biopsy (HR 1.29, 95% CI 1.141.46, p <0.0005) and positive confirmatory biopsy (HR 1.75, 95% CI 1.013.04, p = 0.047) were independent predictors of progression. Of the 61 cases 34 failed due to increased prostate specific antigen, including only 5 with subsequent progression by biopsy criteria. When prostate specific antigen was excluded from progression criteria, only 32 cases progressed, and 2 and 5-year progression-free probability was 91% and 76%, respectively. Using modified criteria as an end point positive confirmatory biopsy was the only independent predictor of progression (HR 3.16, 95% CI 1.417.09, p = 0.005). Conclusions Active surveillance is feasible in patients with low risk prostate cancer and most patients show little evidence of progression within 5 years. There is no clear justification for treating patients in whom prostate specific antigen increases above 10 ng/ml in the absence of other indications of tumor progression. Patients considering active surveillance should undergo confirmatory biopsy to better assess the risk of progression.
AB - Purpose We evaluated predictors of progression after starting active surveillance, especially the role of prostate specific antigen and immediate confirmatory prostate biopsy. Materials and Methods A total of 238 men with prostate cancer met active surveillance eligibility criteria and were analyzed for progression with time. Cox proportional hazards regression was used to evaluate predictors of progression. Progression was evaluated using 2 definitions, including no longer meeting 1) full and 2) modified criteria, excluding prostate specific antigen greater than 10 ng/ml as a criterion. Results Using full criteria 61 patients progressed during followup. The 2 and 5-year progression-free probability was 80% and 60%, respectively. With prostate specific antigen included in progression criteria prostate specific antigen at confirmatory biopsy (HR 1.29, 95% CI 1.141.46, p <0.0005) and positive confirmatory biopsy (HR 1.75, 95% CI 1.013.04, p = 0.047) were independent predictors of progression. Of the 61 cases 34 failed due to increased prostate specific antigen, including only 5 with subsequent progression by biopsy criteria. When prostate specific antigen was excluded from progression criteria, only 32 cases progressed, and 2 and 5-year progression-free probability was 91% and 76%, respectively. Using modified criteria as an end point positive confirmatory biopsy was the only independent predictor of progression (HR 3.16, 95% CI 1.417.09, p = 0.005). Conclusions Active surveillance is feasible in patients with low risk prostate cancer and most patients show little evidence of progression within 5 years. There is no clear justification for treating patients in whom prostate specific antigen increases above 10 ng/ml in the absence of other indications of tumor progression. Patients considering active surveillance should undergo confirmatory biopsy to better assess the risk of progression.
KW - biopsy
KW - disease progression
KW - prostate
KW - prostate-specific antigen
KW - prostatic neoplasms
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U2 - 10.1016/j.juro.2010.09.095
DO - 10.1016/j.juro.2010.09.095
M3 - Article
C2 - 21167529
AN - SCOPUS:78651284982
SN - 0022-5347
VL - 185
SP - 477
EP - 482
JO - Journal of Urology
JF - Journal of Urology
IS - 2
ER -