Active surveillance for localized prostate cancer (prostate cancer)
Two new studies presented at the German Association of Urology congress in 2007, go to the question of whether one can wait for a tumor in stage T1c. The result: Yes, but only in certain cases.
In the first study (Özgür et al.) (Prostate removal) 35 were identified among 323 patients after radical prostatectomy, in which a "low-risk" prostate cancer was diagnosed before surgery.Such a tumor with low risk was assumed, as a PSA level up to 10ng/ml, only a positive (infected) sample at the prostate biopsy, Gleason score and clinical stage T1c 6 and a diagnosed (tumor by needle biopsy, neither palpable nor with imaging visible clinically confined to the prostate).
Regardless of the prostate size (28-110ml) were sampled at biopsy and processed, but only about 6% according to the current guidelines in these patients 4-12 (about two-thirds 6). After surgery, the Gleason score was downgraded in only two cases up and in five cases, the tumor was found localized at 77.1% and locally advanced 28.9%.
The authors conclude that active surveillance (active surveillance) in stage T1c and with only one positive biopsy sample is an appropriate strategy. However, they recommend that you first perform a repeat biopsy with removal of at least 10 samples (standardized transrectal prostate biopsy under TRUS control, see prostate biopsy ), because otherwise overlooked too many requiring treatment tumors could be.
The second study (. Herfs et al) included 430 patients after radical prostatectomy, which had previously been assessed according to the Epstein criteria: In a clinical stage T1c (see above), less than 3 positive samples at the 6-biopsy, of which not to more than 50% may be infected, a Gleason score to 6, a PSA density of less than 0.15 and a free PSA of more than 15% of these criteria are met, and the tumor is considered a high probability to be insignificant ( not require treatment).
This assessment was applied to 64 patients. In order to avoid unnecessary treatment, they were initially followed up an average of 16.5 months had surgery (with PSA check every 6 and biopsy every 12 months) and only at the request or for exceeding the criteria. Compared with the remaining patients were with them the PSAV (PSA increase speed) lower (0.08 to 0.75 ng / ml / year), the PSADT (PSA doubling time) is longer (4.05 versus 2.91 years), the volume-specific PSA level higher (3.86 to 3.3 ng / ml) and the tumor smaller (0.3 to 2.2 cc). The accuracy of prediction was calculated with 55% for an insignificant and 70% for a significant tumor.
The authors conclude that the Epstein criteria for the decision of active surveillance (active surveillance) are only moderately helpful and not enough they crossed for the decision to treat.In addition, why should PSAV, PSA-DT and volume-based PSA values are used to avoid over-treatment and to be able to intervene in time.
Conclusion: Both studies suggest that active surveillance is at a stage T1c prostate cancer in under certain circumstances (by biopsy found) an alternative to immediate treatment. Since such cases are becoming more common because of the increasing use of screening is the accurate prediction of the utmost importance, can acquire the importance of the tumor for the person concerned, if he continues to grow or latent (hidden) remains. However, this goal has not been reached.
Sources (among others):
- Özgür, E., et al.: Active Surveillance (AS) in the low-risk prostate cancer: how reliable is the pre-therapeutic diagnostics? 59 Congress of the German Society of Urology, Berlin, 26.-29.9.07, lecture session 15 "limited local prostate cancer therapy II", Lecture 1 on 9/28/07, and V 15.1 Abstract
- Özgür, E., et al.: TRUS-guided Rebiopbsie is recommended. Biermann, Cologne, Urological News 10/07, 3 The 59th edition Congress of the German Society of Urology, p 9
- Herf, G., et al.: Active Surveillance - a viable Bahandlungsoption to avoid an over treatments in clinically insignificant prostate cancer (PCa)? 59 Congress of the German Society of Urology, Berlin, 26.-29.9.07, lecture session 15 "limited local prostate cancer therapy II", Lecture 2 on 9/28/07, and V 15.2 Abstract
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