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AN ANALYSIS OF MEN WITH CLINICALLY LOCALIZED PROSTATE CANCER WHO DEFERRED DEFINITIVE THERAPY

2004; Lippincott Williams & Wilkins; Volume: 171; Issue: 4 Linguagem: Inglês

10.1097/01.ju.0000118224.54949.78

1527-3792

Manish I. Patel, DINO T. DeCONCINI, Ernesto Lopez‐Corona, M. Ohori, Thomas M. Wheeler, Peter T. Scardino,

Bladder and Urothelial Cancer Treatments

No AccessJournal of UrologyCLINICAL UROLOGY: Original Articles1 Apr 2004AN ANALYSIS OF MEN WITH CLINICALLY LOCALIZED PROSTATE CANCER WHO DEFERRED DEFINITIVE THERAPY MANISH I. PATEL, DINO T. DeCONCINI, ERNESTO LOPEZ-CORONA, MAKATO OHORI, THOMAS WHEELER, and PETER T. SCARDINO MANISH I. PATELMANISH I. PATEL , DINO T. DeCONCINIDINO T. DeCONCINI , ERNESTO LOPEZ-CORONAERNESTO LOPEZ-CORONA , MAKATO OHORIMAKATO OHORI , THOMAS WHEELERTHOMAS WHEELER , and PETER T. SCARDINOPETER T. SCARDINO View All Author Informationhttps://doi.org/10.1097/01.ju.0000118224.54949.78AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract Purpose: We evaluated expectant management of prostate cancer with definitive treatment deferred until evidence of cancer progression in men with low risk, localized cancers. Materials and Methods: We retrospectively reviewed prospectively entered data base records. Patients with low risk cancer who were eligible for definitive therapy but chose deferred management between 1984 and 2001 composed the cohort. Followup included regular evaluations to detect progression by prostate specific antigen (PSA), digital rectal examination, transrectal ultrasound and prostate biopsy. Objective progression was defined by a point scale of changes in prognostic factors. Definitive treatment was recommended in patients with objective progression. Results: The cohort comprised 88 patients with clinical stages T1–2, NX0, M0 prostate cancer, a mean age of 65.3 years and a mean initial PSA of 5.9 ng/ml. Systematic biopsy, which was repeated after the initial diagnostic biopsy, showed no cancer in 61% of cases. During a median followup of 44 months 22 patients had progression. Factors that predicted progression were repeat biopsy showing cancer (p = 0.004) and initial PSA (p = 0.014). Actuarial 5 and 10-year progression-free probabilities were 67% and 55%, respectively. Of the 31 patients treated 17 underwent radical prostatectomy, 13 received radiation therapy and 1 received androgen ablation. Seven men who did not show objective progression were treated because of anxiety. Only 1 patient, who was treated with radiation therapy, had biochemical recurrence. Conclusions: Deferred therapy may be a feasible alternative to curative treatment in select patients with favorable, localized prostate cancer. About half of these patients remain free of progression at 10 years and definitive treatment appeared effective in those with progression. Absent cancer on repeat needle biopsy identified cases highly unlikely to progress. References 1 : Results of conservative management of clinically localized prostate cancer. N Engl J Med1994; 330: 242. Crossref, Medline, Google Scholar 2 : Long-term survival among men with conservatively treated localized prostate cancer. 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Volume 171Issue 4April 2004Page: 1520-1524 Advertisement Copyright & Permissions© 2004 by American Urological Association, Inc.Keywordsprostatic neoplasmstherapydisease progressionprostateMetricsAuthor Information MANISH I. PATEL Nothing to disclose. More articles by this author DINO T. DeCONCINI Nothing to disclose. More articles by this author ERNESTO LOPEZ-CORONA Nothing to disclose. More articles by this author MAKATO OHORI Nothing to disclose. More articles by this author THOMAS WHEELER Financial interest and/or other relationship with Pinter Pharmaceuticals. More articles by this author PETER T. SCARDINO Financial interest and/or other relationship with Proquest, StegaPharm, National Cancer Institute/National Institutes of Health, CAPCURE, AstraZeneca and Sanofi/Synthelab. More articles by this author Expand All Advertisement PDF downloadLoading ...