Expectant management as an option for men with stage T1c prostate cancer: a preliminary study

Abstract

The outcome of patients selecting observation of clinical stage T1c prostate cancer is unknown. A total of 101 men with clinical stage T1c prostate cancer were evaluated, counseled, and monitored in a standard fashion. Altogether, 27 men who elected observation were older and had greater co-morbidity but similar tumor characteristics as compared with 74 men who elected radical prostatectomy. In all, 9 men demonstrated clinical or biochemical evidence of progression after a mean follow-up of 23 months; 4 men who underwent radical prostatectomy had specimen-confined disease and undetectable post-operative levels of PSA. Observation appears to be a viable option for some men with clinical stage T1c prostate cancer.

Treatment Outcomes of Radical Prostatectomy in Potential Candidates for 3 Published Active Surveillance Protocols

“…A total of 3959 (1), 3536 (2), and 2330 (3) men who would have met the Patel9 (1), Choo10 (2), and Mohler11 (3) criteria for active surveillance, respectively, were treated by immediate RRP. Table 1 shows the demographic information for patients meeting criteria for each of the three protocols.…”

“…We identified patients who met the criteria for three published active monitoring protocols: (1) clinically localized disease, biopsy Gleason score ≤ 7, and no significant co-morbidities (Patel et al);9 (2) clinical stage T1b-T2b N0M0 disease, biopsy Gleason score ≤ 7, and PSA ≤ 15 ng/ml (Choo et al)10; or (3) clinical stage T1c disease (Mohler et al)11.…”

“…Finally, Mohler et al defined progression as the development of a suspicious nodule on DRE, lower urinary tract symptoms, gross hematuria, or evidence of metastatic disease 11. Patients were also considered to have progressive disease with three consecutive rises in the serum PSA level with an overall increase of 5 ng/mL or greater.…”

Systematic Review and Meta-analysis of Factors Determining Change to Radical Treatment in Active Surveillance for Localized Prostate Cancer

“…A forward citation search of the five studies [1,[9][10][11][12] included by Martin et al [6] was also performed using the Web of Science database. An update using the same search strategy was carried out by A.J.S.…”

“…The frequency of PSA testing, DRE, and rebiopsy during surveillance varied considerably across the studies. An increase in Gleason grade [12,[14][15][16][17][18][19][20][21][22][23][24][25][26][27][28][29][32][33][34][35][36] was the most common trigger for recommendation of a change to radical treatment, followed by other pathological findings [12,14,16-24, 26,27,29,32-36], PSA or PSA kinetics [9,10,12,14,16,17,19,23,26,[28][29][30]32,34,35], and T stage [14,15,17,19,23,26].…”