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PSA doubling time predicts the outcome after active surveillance in screening‐detected prostate cancer: Results from the European randomized study of screening for prostate cancer, Sweden section
Author(s) -
Ali Khatami,
Gunnar Aus,
JanErik Damber,
Hans Lilja,
Pär Lodding,
Jonas Hugosson
Publication year - 2006
Publication title -
international journal of cancer
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.475
H-Index - 234
eISSN - 1097-0215
pISSN - 0020-7136
DOI - 10.1002/ijc.22161
Subject(s) - medicine , prostatectomy , prostate cancer , stage (stratigraphy) , biopsy , prostate , surgery , cancer , urology , doubling time , biochemical recurrence , prostate specific antigen , gynecology , biology , paleontology , biochemistry , chemistry , in vitro
This study reports the outcome of active surveillance in men with PSA screening‐detected prostate cancer (PC), and PSA doubling time (PSADT) was evaluated as a predictor of selecting patients to active treatment or surveillance. On December 31, 1994, 10,000 men were randomized to biennial PSA testing. Through to December 2004, a total of 660 men were diagnosed with PC, of whom 270 managed with initial surveillance. Of these 270 patients, 104 (39%) received active treatment during follow‐up, 70 radical prostatectomy, 24 radiation and 10 endocrine treatment. Those who received active treatment during follow‐up (mean 63 months) were significantly younger (62.6 vs. 65.5 years, p < 0.0001) and had a shorter PSADT (3.7 vs. 12 years, p < 0.0001). PSA relapse was observed in 9 of 70 patients who received RRP during a mean follow‐up of 37 months. Seven of these nine PSA relapses were in the patients with preoperative PSADT < 2 years. None of the 37 operated patients with a PSADT > 4 years had a PSA relapse. In a Cox regression analysis adjusted for PSA, ratio‐free PSA and amount of cancer in biopsy, only the preoperative PSADT was statistically significant predictor of PSA relapse in p = 0.031. The optimal candidate for surveillance is a man with early, low‐grade, low‐stage PC and a PSADT > 4 years. In younger men with a PSADT of less than 4 years, surveillance does not seem to be a justified alternative, and patient should be informed about the risk with such an approach. © 2006 Wiley‐Liss, Inc.