Prostate Cancer Characteristics Of Potential Candidates For Active Surveillance After Initial And Repeat Biopsy

Main Category: Prostate / Prostate Cancer
Also Included In: Urology / Nephrology;  Cancer / Oncology
Article Date: 28 Jun 2008 - 4:00 PDT

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ORLANDO, FL (UroToday.com) - Active surveillance (AS) is a treatment option in patients diagnosed with low risk prostate cancer. Several recommendations for identification of low risk cancers are published and a repeat biopsy during AS plays a key role in such schemes. Characteristics of men suitable for active surveillance according to published protocols are presented (1-6 below). These investigators report the impact of an immediate repeat biopsy. 1. d'Amico et al. JCO 2002 2.Choo et al. J.Urol. 2002 3.Barocas et al J.Urol suppl. 2007 4.Epstein et al. JAMA 1994 5.Patel et al. J.Urol 2004 6.Mohler et al World J Urol 199

Final pathologic characteristics of 435 consecutive radical prostatectomy patients were analyzed. Low risk groups potentially suitable for AS were characterized according to several published stratification schemes. All patients underwent a second set of biopsies the day before surgery. Final pathology results are reported according to the 1st and 2nd biopsy results.

Applying current stratification schemes after the 1st set of biopsies, 11.7% to 95.6% of the patients were potential candidates for AS. According to the specific scheme 7.8% to 25.5% of the patients already had non-organ confined disease in the final pathology. 41.2% to 58.9% had high-grade cancer in the final specimen. Considering organ-confined disease with high-grade cancer as the ideal constellation for local treatment (window of curability) this constellation was seen in 31.6% to 37.7% of the potential candidates for AS. If the ideal candidates for AS are patients with low risk disease (final pathology pT2, no high-grade cancer), current stratification schemes identified 38.9% to 56.9% correctly. After the 2nd biopsy 2% to 11.9% were not recommended to undergo AS any longer according to the investigated schemes based on the biopsy result (i.e. Gleason 4 in the biopsy). In those patients who met the AS criteria even after the 2nd biopsy non-organ-confined disease and high-grade cancer was found in 5.3% to 23.5% and 31.6% to 56.7%, respectively. 26.3% to 36.9% were in the "window of curability" and 41% to 68.4% were good candidates (pT2, no high-grade cancer) for AS.

They conclude that current AS-schemes harbor the risk of underestimation of the cancer as non-organ confined disease and high-grade cancer is frequently found in such patients. A Re-biopsy does not substantially reduce the risk of underestimation. When patients are counseled for treatment options, this uncertainty needs to be considered.

Presented by Sascha A Ahyai, MD, Roman Heuer, MD, H Rehberg, MD, Hendrik Isbarn, MD, Hans Heinzer, MD, Thorsten Schlomm, MD, Mario Zacharias, MD, Hartwig Huland, MD, Markus Graefen, MD, at the Annual Meeting of the American Urological Association (AUA) - May 17 - 22, 2008. Orange County Convention Center - Orlando, Florida, USA.

Reported by UroToday.com Contributing Editor Christopher P. Evans, MD, FACS

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