Active surveillance may be a viable option for some men, but reclassification of disease risk over time is imperative to ensure outcomes, according to researchers in Toronto, who will present these criteria during the 104th Annual Scientific Meeting of the American Urological Association (AUA).
Active surveillance can offer prostate cancer patients the benefit of an individualized approach based on reclassification of the risk of disease progression over time. Active surveillance using carefully defined criteria can decrease the burden of therapy in patients with slow growing disease, while providing definitive therapy for those with more aggressive disease.
Active surveillance is typically offered to men with slow-growing prostate cancer that may not progress within their lifetime. In other words, the cancer is not likely to be fatal and treatment might cause unnecessary adverse effects. Patients on active surveillance undergo periodic screenings to determine disease progression or risk.
This abstract represents data from the second phase of this study, which was initiated in 1995. Since then, researchers have studied 453 active surveillance candidates to determine the best intervention parameters (at what point physicians should intervene and offer more aggressive treatment options). Study results show that patients who experience a prostate-specific antigen (PSA) doubling time of less than three years or a pathologic progression to Gleason 4+3 are at a higher risk for disease progression and require more aggressive treatment.
In the initial stage of the study, researchers offered active surveillance to prostate cancer patients with favorable risk parameters (Gleason less than or equal to 6, and PSA less than or equal to 10) as an alternative to radical treatment. Patients were followed with serial PSA testing and periodic biopsy. Intervention was offered based on PSA kinetics or grade progression. In 2000, the study was restricted to favorable risk disease. Definitive intervention was offered to those patients with a PSA doubling time of less than three years, Gleason score progression (to 4+3 or greater) or unequivocal clinical progression.