In:
BJU International, Wiley, Vol. 118, No. 1 ( 2016-07), p. 68-76
Abstract:
To determine the frequency of disease reclassification and to identify clinicopathological variables associated with it in patients with favourable‐risk prostate cancer undergoing active surveillance ( AS ). Patients and Methods We assessed 191 men, selected by what may be the most stringent criteria used in AS studies yet conducted, who were enrolled in a prospective cohort AS trial. Clinicopathological characteristics were analysed in a multivariate Cox proportional hazards regression model. Key features were an extended biopsy with a single core positive for Gleason score ( GS ) 3 + 3 ( 〈 3 mm) or 3 + 4 ( 〈 2 mm) and a prostate‐specific antigen ( PSA ) level 〈 4 ng/ mL (adjusted for prostate volume). Biopsies were repeated every 1–2 years and clinical evaluations every 6 months. Disease was reclassified when PSA level increased by 30% from baseline, or when biopsy tumour length increased beyond the enrolment criteria, more than one positive core was detected or any grade increased to a dominant 4 pattern or any 5 pattern. Results Disease was reclassified in 32 patients (16.8%) including upgrading to GS 4 + 3 in five patients (2.6%). The median (interquartile range) follow‐up time among survivors was 3 (1.9–4.6) years. Overall, 13 of the 32 (40.6%) had incremental increases in GS . Tumour length (hazard ratio 2.95, 95% confidence interval [ CI ] 1.34–6.46; P = 0.007) and older age (hazard ratio 1.05, 95% CI 1.00–1.09; P = 0.05) were identified as significant and marginally significant predictors of disease reclassification, respectively. Disease remained stable in 83.2% of patients. Conclusion The need persists for improvements in risk stratification and predictive indicators of cancer progression.
Type of Medium:
Online Resource
ISSN:
1464-4096
,
1464-410X
DOI:
10.1111/bju.2016.118.issue-1
Language:
English
Publisher:
Wiley
Publication Date:
2016
detail.hit.zdb_id:
2019983-1
