|H. Ballentine Carter, MD|
There have been a variety of important questions answered and lessons learned over the past two decades. First, at 10 years approximately 60% of patients will undergo some intervention for prostate cancer. The prompt for intervention is a change in Gleason score or increase in volume of disease in 75%. Importantly, no patient had died of prostate cancer (median follow-up 6.5 years, maximum 15 years).
|Jeff Tosoian, MD|
- PSA is below 10 ng/ml
- Biopsy has a Gleason score of 6
- Cancer is not palpable or is minimally palpable on a digital rectal examination
- Your biopsy has a Gleason score of 6,
- 2 cores or fewer are found to contain cancer,
- Cancer makes up half or less of any core that contains cancer,
- PSA divided by the prostate volume is 0.15 or less, and
- Cancer is not palpable on a digital rectal examination
Third, determining the potential benefits of RP or AS can be difficult since no trial directly compares surgery (radical prostatectomy, RP) to AS. Therefore, complex simulation models need to be employed to detect potential benefits among patients undergoing either RP or AS. Investigators from Hopkins, the Fred Hutchinson Cancer Center, and the University of California-San Francisco (UCSF) teamed up to compare the outcomes of men enrolled in the AS Program at Hopkins with those of men who underwent surgery immediately at Hopkins and UCSF after their cancer was diagnosed. The scientists projected that 2.8 percent of men on AS and 1.6 percent of the men who underwent immediate RP would die of their disease in 20 years. They estimated that the average increase in life expectancy associated with immediate RP was 1.8 months, and that men on AS would remain free of treatment for an additional 6.4 years as compared to men who had immediate treatment. "These findings suggest that men enrolled in the Johns Hopkins AS Program are at low risk of losing a window of opportunity for cure if they are carefully monitored," Carter says.
Some of this blog has been extracted from Prostate Cancer Discovery, Volume 10, Winter 2014.
1. Tosoian JJ, Trock BJ, Landis P, Feng Z, Epstein JI, Partin AW, Walsh PC, Carter HB.Active surveillance program for prostate cancer: an update of the Johns Hopkins experience.J Clin Oncol. 2011 Jun 1;29(16):2185-90. doi: 10.1200/JCO.2010.32.8112. Epub 2011 Apr 4.
2. Tosoian JJ, JohnBull E, Trock BJ, Landis P, Epstein JI, Partin AW, Walsh PC, Carter HB.Pathological outcomes in men with low risk and very low risk prostate cancer: implications on the practice of active surveillance.J Urol. 2013 Oct;190(4):1218-22. doi: 10.1016/j.juro.2013.04.071. Epub 2013 Apr 30.
3. Xia J, Trock BJ, Cooperberg MR, Gulati R, Zeliadt SB, Gore JL, Lin DW, Carroll PR, Carter HB, Etzioni R.Prostate cancer mortality following active surveillance versus immediate radical prostatectomy. Clin Cancer Res. 2012 Oct 1;18(19):5471-8. doi: 10.1158/1078-0432.CCR-12-1502. Epub 2012 Sep 24.