Real Time Active Surveillance for Localized Prostate Cancer: A Dual Surgeon Experience
CUA Online Library. patel p. 06/22/13; 31434; UP-55
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Abstract
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Introduction and Objective: Active surveillance, which entails initial expectant management rather than immediate therapy, has become the standard of care for individuals with favourable-risk prostate cancer. Curative intent is undertaken when there is evidence that the patient is at an increased risk of disease progression. However, due to patient preference to eg. continue surveillance with unfavorable disease or undergo curative procedures despite favorable-risk disease, active surveillance guidelines and ‘real life’ surveillance may be substantially different. We aimed to compare the timing of prostate cancer surveillance between the Calgary experience and recommended guidelines. Further, we set out to determine the specific PSA, PSA velocity, interval time for screening and clinical outcomes in patients entered in our active surveillance program.
Methods: A chart review was conducted utilizing the Electronic Medical Record (Wolf) system for 2 urologist’s data for 114 patients on prostate cancer active surveillance. Biopsy intervals with Gleason scores, PSA intervals and values, complications and outcomes were extracted from patient charts.
Results: Of 114 patients on active surveillance (mean age 61.3), 112 underwent at least one prostate biopsy since October 2001, 53 had a repeat biopsy and of those 9 had a third biopsy. The mean time between the first and second biopsy was 16.5 months (range 3 – 37), and 27.6 months (range 18 – 56) between the 2nd and 3rd biopsy. The Calgary experience had biopsies occur 4.5 months later than the suggested guidelines for the 1st interval. Repeat PSAs were taken at an average of 6.2 months (range 2 – 12.5). At the end of the study period, 96 patients were still on active surveillance, 2 were lost to follow up and 12 required treatment. Of the 12 patients who required intervention, 5 advanced from gleason 3+3 to 3+4 upon repeat biopsy, and only one advanced from gleason 3+3 to 4+3.
Conclusion: The Calgary experience observed extended intervals between biopsies relative to suggested guidelines. However, results for disease advancement based on histological Gleason scores, suggest that the Calgary experience still provided early enough identification of prostate cancer progression in our cohort.
Methods: A chart review was conducted utilizing the Electronic Medical Record (Wolf) system for 2 urologist’s data for 114 patients on prostate cancer active surveillance. Biopsy intervals with Gleason scores, PSA intervals and values, complications and outcomes were extracted from patient charts.
Results: Of 114 patients on active surveillance (mean age 61.3), 112 underwent at least one prostate biopsy since October 2001, 53 had a repeat biopsy and of those 9 had a third biopsy. The mean time between the first and second biopsy was 16.5 months (range 3 – 37), and 27.6 months (range 18 – 56) between the 2nd and 3rd biopsy. The Calgary experience had biopsies occur 4.5 months later than the suggested guidelines for the 1st interval. Repeat PSAs were taken at an average of 6.2 months (range 2 – 12.5). At the end of the study period, 96 patients were still on active surveillance, 2 were lost to follow up and 12 required treatment. Of the 12 patients who required intervention, 5 advanced from gleason 3+3 to 3+4 upon repeat biopsy, and only one advanced from gleason 3+3 to 4+3.
Conclusion: The Calgary experience observed extended intervals between biopsies relative to suggested guidelines. However, results for disease advancement based on histological Gleason scores, suggest that the Calgary experience still provided early enough identification of prostate cancer progression in our cohort.
Introduction and Objective: Active surveillance, which entails initial expectant management rather than immediate therapy, has become the standard of care for individuals with favourable-risk prostate cancer. Curative intent is undertaken when there is evidence that the patient is at an increased risk of disease progression. However, due to patient preference to eg. continue surveillance with unfavorable disease or undergo curative procedures despite favorable-risk disease, active surveillance guidelines and ‘real life’ surveillance may be substantially different. We aimed to compare the timing of prostate cancer surveillance between the Calgary experience and recommended guidelines. Further, we set out to determine the specific PSA, PSA velocity, interval time for screening and clinical outcomes in patients entered in our active surveillance program.
Methods: A chart review was conducted utilizing the Electronic Medical Record (Wolf) system for 2 urologist’s data for 114 patients on prostate cancer active surveillance. Biopsy intervals with Gleason scores, PSA intervals and values, complications and outcomes were extracted from patient charts.
Results: Of 114 patients on active surveillance (mean age 61.3), 112 underwent at least one prostate biopsy since October 2001, 53 had a repeat biopsy and of those 9 had a third biopsy. The mean time between the first and second biopsy was 16.5 months (range 3 – 37), and 27.6 months (range 18 – 56) between the 2nd and 3rd biopsy. The Calgary experience had biopsies occur 4.5 months later than the suggested guidelines for the 1st interval. Repeat PSAs were taken at an average of 6.2 months (range 2 – 12.5). At the end of the study period, 96 patients were still on active surveillance, 2 were lost to follow up and 12 required treatment. Of the 12 patients who required intervention, 5 advanced from gleason 3+3 to 3+4 upon repeat biopsy, and only one advanced from gleason 3+3 to 4+3.
Conclusion: The Calgary experience observed extended intervals between biopsies relative to suggested guidelines. However, results for disease advancement based on histological Gleason scores, suggest that the Calgary experience still provided early enough identification of prostate cancer progression in our cohort.
Methods: A chart review was conducted utilizing the Electronic Medical Record (Wolf) system for 2 urologist’s data for 114 patients on prostate cancer active surveillance. Biopsy intervals with Gleason scores, PSA intervals and values, complications and outcomes were extracted from patient charts.
Results: Of 114 patients on active surveillance (mean age 61.3), 112 underwent at least one prostate biopsy since October 2001, 53 had a repeat biopsy and of those 9 had a third biopsy. The mean time between the first and second biopsy was 16.5 months (range 3 – 37), and 27.6 months (range 18 – 56) between the 2nd and 3rd biopsy. The Calgary experience had biopsies occur 4.5 months later than the suggested guidelines for the 1st interval. Repeat PSAs were taken at an average of 6.2 months (range 2 – 12.5). At the end of the study period, 96 patients were still on active surveillance, 2 were lost to follow up and 12 required treatment. Of the 12 patients who required intervention, 5 advanced from gleason 3+3 to 3+4 upon repeat biopsy, and only one advanced from gleason 3+3 to 4+3.
Conclusion: The Calgary experience observed extended intervals between biopsies relative to suggested guidelines. However, results for disease advancement based on histological Gleason scores, suggest that the Calgary experience still provided early enough identification of prostate cancer progression in our cohort.
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