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Defining Intermediate-Risk Prostate Cancer Suitable for Active Surveillance.

Artikel i vetenskaplig tidskrift
Författare Stacy Loeb
Yasin Folkvaljon
Ola Bratt
David Robinson
Pär Stattin
Publicerad i The Journal of urology
ISSN 1527-3792
Publiceringsår 2018
Publicerad vid Institutionen för kliniska vetenskaper, Avdelningen för urologi
Språk en
Länkar dx.doi.org/10.1016/j.juro.2018.09.0...
www.ncbi.nlm.nih.gov/entrez/query.f...
Ämneskategorier Urologi och andrologi, Cancer och onkologi

Sammanfattning

Active surveillance (AS) for intermediate-risk prostate cancer (PCa) is controversial. Many AS programs are limited to grade group (GG) 1 (Gleason 6) and PSA<10 ng/ml. However, recent guidelines state that AS can be considered for limited GG2 (Gleason 3+4), despite limited data on outcomes. Our objective was to compare prostatectomy outcomes between subgroups of intermediate-risk versus low-risk PCa.We performed an observational study in the National Prostate Cancer Register (NPCR) of Sweden, including 98% of PCa nationwide. From 2009-2012, 5087 men with low-risk (GG1, PSA<10, and ≤cT2) and intermediate-risk PCa (GG2 or PSA 10-20, or T2) underwent radical prostatectomy. We compared upgrading and upstaging between groups, based on the UCSF Cancer of the Prostate Risk Assessment (CAPRA) scores and published AS criteria. Results were validated in an independent dataset of cases diagnosed 2013-2016.Men with GG1, PSA 10-15ng/ml and PSA density <0.15 had no significant difference in upgrading and adverse pathology compared to low-risk PCa. PSA>15 or GG2 were associated with a significantly greater risk of aggressive PCa. Men with low-risk CAPRA scores (0-2) and GG2 had almost a 3-fold increased risk of upgrading and 2-fold increased risk of adverse pathology compared to low-risk CAPRA GG1.Expanding the PSA threshold to 15 ng/ml for GG1 PCa would allow more men to choose AS and is unlikely to compromise outcomes, particularly if PSA density is low. By contrast, caution should be exercised in offering AS to men with PSA>15 or GG2.

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