Role of prostate specific antigen and immediate confirmatory biopsy in predicting progression during active surveillance for low risk prostate cancer Journal Article

Authors: Adamy, A.; Yee, D. S.; Matsushita, K.; Maschino, A.; Cronin, A.; Vickers, A.; Guillonneau, B.; Scardino, P. T.; Eastham, J. A.
Article Title: Role of prostate specific antigen and immediate confirmatory biopsy in predicting progression during active surveillance for low risk prostate cancer
Abstract: Purpose We evaluated predictors of progression after starting active surveillance, especially the role of prostate specific antigen and immediate confirmatory prostate biopsy. Materials and Methods A total of 238 men with prostate cancer met active surveillance eligibility criteria and were analyzed for progression with time. Cox proportional hazards regression was used to evaluate predictors of progression. Progression was evaluated using 2 definitions, including no longer meeting 1) full and 2) modified criteria, excluding prostate specific antigen greater than 10 ng/ml as a criterion. Results Using full criteria 61 patients progressed during followup. The 2 and 5-year progression-free probability was 80% and 60%, respectively. With prostate specific antigen included in progression criteria prostate specific antigen at confirmatory biopsy (HR 1.29, 95% CI 1.141.46, p <0.0005) and positive confirmatory biopsy (HR 1.75, 95% CI 1.013.04, p = 0.047) were independent predictors of progression. Of the 61 cases 34 failed due to increased prostate specific antigen, including only 5 with subsequent progression by biopsy criteria. When prostate specific antigen was excluded from progression criteria, only 32 cases progressed, and 2 and 5-year progression-free probability was 91% and 76%, respectively. Using modified criteria as an end point positive confirmatory biopsy was the only independent predictor of progression (HR 3.16, 95% CI 1.417.09, p = 0.005). Conclusions Active surveillance is feasible in patients with low risk prostate cancer and most patients show little evidence of progression within 5 years. There is no clear justification for treating patients in whom prostate specific antigen increases above 10 ng/ml in the absence of other indications of tumor progression. Patients considering active surveillance should undergo confirmatory biopsy to better assess the risk of progression. © 2011 American Urological Association Education and Research, Inc.
Keywords: adult; cancer survival; human tissue; aged; major clinical study; cancer risk; cancer patient; cancer staging; follow up; prostate specific antigen; progression free survival; biopsy; prostate cancer; prostate-specific antigen; prostatic neoplasms; prostate; proportional hazards model; probability; disease progression; prostate biopsy; predictor variable; immediate confirmatory prostate biopsy
Journal Title: Journal of Urology
Volume: 185
Issue: 2
ISSN: 0022-5347
Publisher: Elsevier Science, Inc.  
Date Published: 2011-02-01
Start Page: 477
End Page: 482
Language: English
DOI: 10.1016/j.juro.2010.09.095
PROVIDER: scopus
PUBMED: 21167529
PMCID: PMC3417207
Notes: --- - "Cited By (since 1996): 1" - "Export Date: 4 March 2011" - "CODEN: JOURA" - "Source: Scopus"
Altmetric Score
MSK Authors
  1. Peter T Scardino
    615 Scardino
  2. Andrew J Vickers
    544 Vickers
  3. Angel M Cronin
    144 Cronin
  4. David Scott Yee
    19 Yee
  5. James Eastham
    422 Eastham