Now, keep up to date
with daily feeds of newly posted stories
about America's Seniors...click on the box
to the left
New Active Surveillance Parameters allow for
more individualized Prostate Patient Care
Newswise — Active surveillance can offer
prostate cancer patients the benefit of an
individualized approach based on
reclassification of the risk of disease
progression over time.
Active surveillance may be a viable option
for some men, but reclassification of
disease risk over time is imperative to
ensure outcomes, according to researchers in
Toronto, who will present these criteria
during the 104th Annual Scientific Meeting
of the American Urological Association (AUA).
Active surveillance using carefully defined
criteria can decrease the burden of therapy
in patients with slow growing disease, while
providing definitive therapy for those with
more aggressive disease.
Active surveillance is typically offered to
men with slow-growing prostate cancer that
may not progress within their lifetime.
In other words, the cancer is not likely to
be fatal and treatment might cause
unnecessary adverse effects.
Patients on active surveillance undergo
periodic screenings to determine disease
progression or risk.
This abstract represents data from the
second phase of this study, which was
initiated in 1995.
Since then, researchers have studied 453
active surveillance candidates to determine
the best intervention parameters (at what
point physicians should intervene and offer
more aggressive treatment options).
Study
results show that patients who experience a
prostate-specific antigen (PSA) doubling
time of less than three years or a
pathologic progression to Gleason 4+3 are at
a higher risk for disease progression and
require more aggressive treatment.
In the initial stage of the study,
researchers offered active surveillance to
prostate cancer patients with favorable risk
parameters (Gleason less than or equal to 6,
and PSA less than or equal to 10) as an
alternative to radical treatment.
Patients
were followed with serial PSA testing and
periodic biopsy. Intervention was offered
based on PSA kinetics or grade progression.
In 2000, the study was restricted to
favorable risk disease. Definitive
intervention was offered to those patients
with a PSA doubling time of less than three
years, Gleason score progression (to 4+3 or
greater) or unequivocal clinical
progression.
Of the 453 patients on the program, the
median age is currently 70, the median
follow-up is 7.2 years, the overall survival
is 83 percent and the prostate cancer
survival is 99 percent.
Five of the 453 patients have died of
prostate cancer; 35 percent have been
reclassified as higher risk and offered
definitive therapy.
The most common indications for treatment
were a PSA doubling time of less than three
years or Gleason upgrading.
Of the 137 patients treated surgically, the
PSA failure rate (rising PSA) was 52
percent.
Patients with biochemical failure after
radical therapy constitute 15 percent of the
overall study group. The ratio of
non-prostate cancer to prostate cancer
mortality was 16.
“In terms of evaluating the outcome from any
prostate cancer therapy or watchful waiting
protocol, the duration of observation is
critical.
"Although
7.2 years of follow-up, as noted here, seems
long, many investigators would be careful
with any conclusions until the follow-up
time exceeded 10 years,” said Kevin T.
McVary, MD, an AUA spokesman.
“Regardless, watchful waiting is an
appropriate and commonly practiced care for
selected men with prostate cancer.”
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
16,000 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 for
members and their patients.
... ..
...
...