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Active surveillance a viable option for
low-risk Prostate Cancer
Newswise — ORLANDO, FL, May 18,2008--Active
surveillance remains a viable option for
low-risk, localized prostate cancer,
according to two studies presented today
during the Annual Scientific Meeting of the
American Urological Association (AUA), yet
researchers point out a strong need for
regular monitoring and development of
stronger clinical predictors of progression.
Researchers from the University of Texas
Health Science Center in San Antonio
evaluated the efficacy of digital rectal
exam (DRE), prostate-specific antigen (PSA)
testing, repeat biopsy and endorectal
magnetic resonance imaging (MRI) in
accurately monitoring disease progression.
Researchers conducted a retrospective review
of 80 patients with low-risk prostate cancer
(stage T1-T2, NX0, MO) who were managed with
active surveillance from 2004 to 2007.
Patients (mean age 65) underwent routine
clinical checkups with DRE and PSA every
four months and repeat biopsy at 18 months.
Select patients (12) also underwent
endorectal MRI.
The study shows that PSA and DRE were
unreliable in predicting disease
progression. Of the 41 percent of patients
with an initial positive DRE, 42 percent
with a previously abnormal DRE had a
subsequent normal DRE. PSA at the time of
repeat biopsy was insufficient in predicting
subsequent positive biopsy, and a majority
with a positive repeat biopsy also had a
decreased PSA level.
Endorectal MRI, not currently part of the
routine surveillance protocol, was the most
reliable predictor, and showed location and
disease stage as expected in 50 percent of
the patients being followed by MRI.
The second study, a multi-institutional
retrospective review of data from four North
American academic centers – Cleveland Clinic
Foundation, Memorial Sloan-Kettering Cancer
Center, University of British Columbia and
University of Miami – indicated that active
surveillance for appropriately selected
patients with low-risk prostate cancer
appears to be safe, durable and associated
with low risk of systemic progression.
Cancer detected on re-biopsy and the total
number of involved cores are associated with
a lower likelihood of remaining on active
surveillance.
This study evaluated actuarial rates,
incidence of metastatic disease,
pathological findings subsequently
undergoing radical prostatectomy and
predictors of remaining on active
surveillance in patients with low-risk,
localized prostate cancer .
The study cohort consisted of 262 patients
(aged 75 and younger) with localized
prostate cancer and low-risk
clinicopathologic features who had at least
two biopsies prior to going on active
surveillance.
Median follow-up was 29.7 months. The
presence of cancer in the second biopsy and
the number of positive cores at first and
second biopsy (combined) were strong
indicators of progression requiring active
treatment.
Of the group, 43 patients subsequently
underwent primary therapy (radical
prostatectomy, radiation therapy or androgen
deprivation). The one- two and five-year
actuarial probabilities of remaining on
active surveillance were 95 percent, 01
percent and 75 percent.
About the American
Urological Association
Founded in 1902 and headquartered near
Baltimore, Maryland, the American Urological
Association is the pre-eminent professional
organization for urologists, with more than
15,000 members throughout the world. An
educational nonprofit organization, the AUA
pursues its mission of fostering the highest
standards of urologic care by carrying out a
wide variety of programs members and their
patients, including UrologyHealth.org, an
award-winning on-line patient education
resource, and the American Urological
Association Foundation, Inc.
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