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Role of Prostate Specific Antigen and Immediate Confirmatory Biopsy in Predicting Progression During Active Surveillance for Low Risk Prostate Cancer

2010; Lippincott Williams & Wilkins; Volume: 185; Issue: 2 Linguagem: Inglês

10.1016/j.juro.2010.09.095

1527-3792

Ari Adamy, David S. Yee, Kazuhito Matsushita, Alexandra C. Maschino, Angel M. Cronin, Andrew J. Vickers, Bertrand Guillonneau, Peter T. Scardino, James A. Eastham,

Hepatitis B Virus Studies

No AccessJournal of UrologyAdult Urology1 Feb 2011Role of Prostate Specific Antigen and Immediate Confirmatory Biopsy in Predicting Progression During Active Surveillance for Low Risk Prostate Cancer Ari Adamy, David S. Yee, Kazuhito Matsushita, Alexandra Maschino, Angel Cronin, Andrew Vickers, Bertrand Guillonneau, Peter T. Scardino, and James A. Eastham Ari AdamyAri Adamy Urology Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, New York More articles by this author , David S. YeeDavid S. Yee Urology Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, New York More articles by this author , Kazuhito MatsushitaKazuhito Matsushita Urology Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, New York More articles by this author , Alexandra MaschinoAlexandra Maschino Department of Epidemiology and Biostatistics, Memorial Sloan-Kettering Cancer Center, New York, New York More articles by this author , Angel CroninAngel Cronin Department of Epidemiology and Biostatistics, Memorial Sloan-Kettering Cancer Center, New York, New York More articles by this author , Andrew VickersAndrew Vickers Department of Epidemiology and Biostatistics, Memorial Sloan-Kettering Cancer Center, New York, New York More articles by this author , Bertrand GuillonneauBertrand Guillonneau Urology Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, New York More articles by this author , Peter T. ScardinoPeter T. Scardino Urology Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, New York More articles by this author , and James A. EasthamJames A. Eastham Urology Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, New York More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2010.09.095AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract 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 1.14–1.46, p <0.0005) and positive confirmatory biopsy (HR 1.75, 95% CI 1.01–3.04, 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 1.41–7.09, 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. References 1 : Lead time and overdiagnosis in prostate-specific antigen screening: importance of methods and context. J Natl Cancer Inst2009; 101: 374. Google Scholar 2 : Active surveillance for prostate cancer with selective delayed definitive therapy. Clin Prostate Cancer2005; 4: 45. Google Scholar 3 : Contemporary trends in low risk prostate cancer: risk assessment and treatment. 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Volume 185Issue 2February 2011Page: 477-482 Advertisement Copyright & Permissions© 2011 by American Urological Association Education and Research, Inc.Keywordsdisease progressionprostate-specific antigenprostatebiopsyprostatic neoplasmsMetricsAuthor Information Ari Adamy Urology Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, New York More articles by this author David S. Yee Urology Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, New York More articles by this author Kazuhito Matsushita Urology Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, New York More articles by this author Alexandra Maschino Department of Epidemiology and Biostatistics, Memorial Sloan-Kettering Cancer Center, New York, New York More articles by this author Angel Cronin Department of Epidemiology and Biostatistics, Memorial Sloan-Kettering Cancer Center, New York, New York More articles by this author Andrew Vickers Department of Epidemiology and Biostatistics, Memorial Sloan-Kettering Cancer Center, New York, New York More articles by this author Bertrand Guillonneau Urology Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, New York More articles by this author Peter T. Scardino Urology Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, New York More articles by this author James A. Eastham Urology Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, New York More articles by this author Expand All Advertisement PDF downloadLoading ...