SAN DIEGO—Active surveillance (AS) may be an appropriate management option in carefully selected prostate cancer (PCa) patients with a baseline PSA level of 10 ng/mL or higher, according to study findings presented at the American Urological Association annual meeting. The study showed that these patients are no more likely to experience pathologic progression that patients with lower PSA levels at baseline.
The study, by Paul Toren, MD, and colleagues at the University of Toronto, included 697 patients on AS who had clinical stage T1c-T2a disease, a Gleason score of 6 or less, and three or fewer prostate biopsy cores positive for cancer with no more than 50% of a core involved at initial diagnostic biopsy. The cohort had a mean age of 64 years at diagnosis and a median follow-up of 46.2 months. The investigators divided subjects into three groups: those who started AS with a PSA level greater than 10; those whose PSA level increased to 10 or higher during follow-up; and men who had a PSA level below 10 throughout AS.
Results showed that patients starting AS with a PSA greater than 10 did not have a higher rate of pathologic progression at first or subsequent repeat biopsy compared with patients who had a lower PSA at diagnosis. The investigators defined pathologic progression as biopsy parameters exceeding the entry criteria limits.
A total of 103 patients underwent radical prostatectomy (RP). Gleason scores at RP were similar among the groups, but five patients who had a PSA increase to 10 or higher during follow-up had a Gleason 8 or higher compared with no patients with a baseline PSA level of 10 or higher and three patients who had a PSA level below 10.