An analysis of men with clinically localized prostate cancer who deferred definitive therapy Journal Article
| Authors: | Patel, M. I.; Deconcini, D. T.; Lopez-Corona, E.; Ohori, M.; Wheeler, T.; Scardino, P. T. |
| Article Title: | An analysis of men with clinically localized prostate cancer who deferred definitive therapy |
| Abstract: | Purpose: We evaluated expectant management of prostate cancer with definitive treatment deferred until evidence of cancer progression in men with low risk, localized cancers. Materials and Methods: We retrospectively reviewed prospectively entered data base records. Patients with low risk cancer who were eligible for definitive therapy but chose deferred management between 1984 and 2001 composed the cohort. Followup included regular evaluations to detect progression by prostate specific antigen (PSA), digital rectal examination, transrectal ultrasound and prostate biopsy. Objective progression was defined by a point scale of changes in prognostic factors. Definitive treatment was recommended in patients with objective progression. Results: The cohort comprised 88 patients with clinical stages T1-2, NX0, MO prostate cancer, a mean age of 65.3 years and a mean initial PSA of 5.9 ng/ml. Systematic biopsy, which was repeated after the initial diagnostic biopsy, showed no cancer in 61% of cases. During a median followup of 44 months 22 patients had progression. Factors that predicted progression were repeat biopsy showing cancer (p = 0.004) and initial PSA (p = 0.014). Actuarial 5 and 10-year progression-free probabilities were 67% and 55%, respectively. Of the 31 patients treated 17 underwent radical prostatectomy, 13 received radiation therapy and 1 received androgen ablation. Seven men who did not show objective progression were treated because of anxiety. Only 1 patient, who was treated with radiation therapy, had biochemical recurrence. Conclusions: Deferred therapy may be a feasible alternative to curative treatment in select patients with favorable, localized prostate cancer. About half of these patients remain free of progression at 10 years and definitive treatment appeared effective in those with progression. Absent cancer on repeat needle biopsy identified cases highly unlikely to progress. |
| Keywords: | adult; cancer survival; controlled study; human tissue; treatment outcome; aged; middle aged; retrospective studies; major clinical study; review; cancer localization; cancer recurrence; cancer growth; cancer risk; cancer radiotherapy; cancer staging; follow up; follow-up studies; treatment indication; prostate specific antigen; cohort analysis; risk factors; retrospective study; time factors; risk assessment; prostatic neoplasms; prostate; feasibility study; prostatectomy; disease progression; prostate biopsy; anxiety; transrectal ultrasonography; therapy; catheter ablation; prostate carcinoma; humans; prognosis; human; male; priority journal |
| Journal Title: | Journal of Urology |
| Volume: | 171 |
| Issue: | 4 |
| ISSN: | 0022-5347 |
| Publisher: | Elsevier Science, Inc. |
| Date Published: | 2004-04-01 |
| Start Page: | 1520 |
| End Page: | 1524 |
| Language: | English |
| DOI: | 10.1097/01.ju.0000118224.54949.78 |
| PROVIDER: | scopus |
| PUBMED: | 15017211 |
| DOI/URL: | |
| Notes: | J. Urol. -- Cited By (since 1996):128 -- Export Date: 16 June 2014 -- CODEN: JOURA -- Source: Scopus |
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