Prostate cancer news reports: Sunday, November 8, 2009

This weekend’s news report includes items on:

  • Numbers of biopsy cores and accuracy of diagnosis for focal therapy
  • Early data from the Prostate Cancer Research International: Active Surveillance (PRIAS) study
  • Ultrasensitive PSA testing and risk of progression following radical prostatectomy

Tsivian et al. have published data from a single, tertiary care institution clearly indicating that, compared to routine, office-based, sextant and extended biopsies, even a 12-core biopsy is insufficient to accurately identify candidates for focal therapy. Most specialists would currently suggest that a template-guided, saturation biopsy is an essential element in the accurate identification of men who are potential candidates for focal therapy, and itb is well knownj that even template-guided, saturation biopsies are not necessarily sufficient to eliminate the risk of prostate cancer in the untreated lobe of the prostate in patients receiving focal therapy.

Short-term outcomes of the prospective international Prostate Cancer Research International: Active Surveillance (PRIAS) study of active surveillance (AS) for early-stage, localized prostate cancer have been reported by van den Bergh et al. Data from the first 500 (of > 950) participants have been analyzed, and all patients had  asymptomatic T1c/T2 prostate cancer, with a PSA level of ≤ 10.0 ng/ml, a PSA density of < 0.2 ng/ml/ml, a Gleason score of ≤ 3 + 3 = 6, and one or two positive biopsy cores. The follow-up protocol consisted of frequent PSA measurements, DREs, and standard repeat biopsies (the first after 1 year). The 2-year survival rate free from active therapy was 73 percent. Of the 82 men who changed to active therapy during the follow-up periofd, 68 (83 percent) did so based on the formal study protocol. Of the 261 repeat biopsies available for analysis, 90 (34 percent) showed no cancer, while 57 (22 percent) showed a Gleason score of > 6 or more than two positive biopsy cores. There was a relatively unfavourable PSA doubling time of 0-10 years in 53 percent (102/194) and 62 percent (33/53) of men with favourable and unfavourable re-biopsy results, respectively. After RP, 4/24 men (17 percent) had T3 disease and 12/24 men (50 percent) had a Gleason score of > 6. The aiuthors conclude that, “AS seems feasible, but mortality outcomes are unknown. A strict follow-up protocol including standard 1-year repeat biopsies resulted in a quarter of men stopping AS after 2 years.”

Chang et al. have reported that the time to a first detectable ultrasensitive PSA after radical prostatectomy may be usable to identify men at low-risk for prostate cancer recurrence. Specifically, their data suggest that patients with an undetectable ultrasensitive PSA 2 years after surgery are unlikely to develop a PSA doubling time of < 9 months after biochemical failure. They reached this conclusion based on a review of data in the Shared Equal Access Regional Cancer Hospital (SEARCH) database. Patients were stratified into low-risk (PSADT ≥ 9 months) and high-risk (PSADT < 9 months) cohorts. The analysis included 89 low- and 26 high-risk men, so this is a small, hypothesis-generating study and can not be considered to be “established fact” at this time.

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