Gleason score 7 screen‐detected prostate cancers initially managed expectantly: outcomes in 50 men
- 11 May 2009
- journal article
- research article
- Published by Wiley in BJU International
- Vol. 103 (11), 1472-1477
- https://doi.org/10.1111/j.1464-410x.2008.08281.x
Abstract
To assess whether men newly diagnosed with Gleason 7 prostate cancer are eligible for active surveillance (AS) instead of radical treatment. AS is an appropriate initial strategy in selected men who are presently diagnosed with prostate cancer, as many tumours will not progress during a patient's lifetime. Cancer-specific-, overall and treatment-free survival were analysed retrospectively in men with Gleason score 7 cancer who were initially managed expectantly. All were screen-detected in four centres of the European Randomized Study of Screening for Prostate Cancer. In 50 men active therapy was initially withheld if they had Gleason 7 disease; 29 of 50 (58%) would otherwise have been suitable for AS, as they had a prostate-specific antigen (PSA) level of <= 10.0 ng/mL, a PSA density of < 0.2 ng/mL/mL, stage T1c/T2, and two or fewer positive biopsy-cores; 44 of 50 (88%) had a Gleason score 3 + 4 = 7. The mean (range) age of the men was 69.5 (59.6-76.2) years and the median (interquartile range) follow-up was 2.6 (0.8-5.0) years; the mean American Society of Anesthesiologists score was 1.8. The 6-year cancer-specific survival (nine patients at risk) was 100%, which sharply contrasted with the 68% overall survival. Men alive at the time of analysis had a favourable PSA level and PSA-doubling time. The 6-year treatment-free survival was only 59%, with most patients switching to active therapy, justified on the basis of their PSA level. However, men with otherwise favourable tumour characteristics and a Gleason score of 3 + 4 = 7 remained treatment-free significantly longer than their counterparts with unfavourable other tumour features and a Gleason score of 4 + 3 = 7. In selected patients with screen-detected Gleason 3 + 4 = 7 prostate cancer, AS might be an option, especially in those with comorbidity and/or a short life-expectancy.This publication has 18 references indexed in Scilit:
- Predicting the Probability of Deferred Radical Treatment for Localised Prostate Cancer Managed by Active SurveillanceEuropean Urology, 2008
- Assessment of causes of death in a prostate cancer screening trialInternational Journal of Cancer, 2007
- How much does Gleason grade of follow‐up biopsy differ from that of initial biopsy in untreated, Gleason score 4–7, clinically localized prostate cancer?The Prostate, 2007
- Innovations in Serum and Urine Markers in Prostate Cancer: Current European Research in the P-Mark ProjectEuropean Urology, 2005
- Prostate Cancer and the Will Rogers PhenomenonJNCI Journal of the National Cancer Institute, 2005
- Radical Prostatectomy versus Watchful Waiting in Early Prostate CancerThe New England Journal of Medicine, 2005
- Early outcomes of active surveillance for localized prostate cancerBJU International, 2005
- The Finnish trial of prostate cancer screening: where are we now?BJU International, 2003
- Temporarily Deferred Therapy (watchful waiting) for Men Younger Than 70 Years and With Low-Risk Localized Prostate Cancer in the Prostate-Specific Antigen EraJournal of Clinical Oncology, 2003
- Feasibility Study: Watchful Waiting For Localized Low To Intermediate Grade Prostate Carcinoma With Selective Delayed Intervention Based On Prostate Specific Antigen, Histological And/Or Clinical ProgressionJournal of Urology, 2002