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European Urology

Volume 58, issue 6, pages e53-e62, December 2010

Prostate Cancer

Careful Selection and Close Monitoring of Low-Risk Prostate Cancer Patients on Active Surveillance Minimizes the Need for Treatment eulogo1

Mark S. Soloway, Cynthia T. Soloway, Ahmed Eldefrawy, Kristell Acosta, Bruce Kava and Murugesan Manoharan

Accepted 12 August 2010, Published online 20 August 2010, pages 831 - 835

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Fig. 1 Outcome of treated active surveillance patients with total prostatectomy (TP) versus initially treated TP patients.AS = active surveillance; LHRH = luteinizing hormone-releasing hormone; EBRT = external-beam radiation therapy; TP = total prostatectomy; EPE = extraprostatic extension; SVI = seminal vesical invasion; BCR = biochemical recurrence; PCa = prostate cancer.

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References in context

  • Twelve of the 32 treated patients had TP, 14 had interstitial or external-beam RT (EBRT), and 6 underwent hormone therapy (HT; Fig. 1).
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  • In the 219 patients, 59 (27%) had a positive margin, 17 (7.5%) had extraprostatic extension (EPE), and 4 (2%) had seminal vesicle invasion (SVI; Fig. 1).
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  • All patients were free of SVI, and one patient had EPE (Fig. 1).
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Fig. 2 Kaplan-Meier treatment-free survival curve.

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References in context

  • A Kaplan-Meier analysis predicted that 85.7% of the entire AS cohort would be free from treatment at 5 yr (Fig. 2).
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Table 1 Demographics of the active surveillance (AS) cohort versus treated AS patients

AS cohort Treated AS patients
No. of patients 230 32
Age at diagnosis, yr Mean: 63.4 Mean: 65.3
Median: 64 Median: 68
Range: 42–79
PSA at diagnosis, ng/ml Mean: 5.07 Mean: 5.66
Median: 4.80 Median: 5.14
Length of follow-up, mo Mean: 44 Mean: 33
Median: 35 Median: 31
Range: 12–208 Range: 12–92
Age at Tx, yr N/A Mean: 68.5
Median: 70
Range: 44–84
First SHIM score Mean: 14.2 Mean: 16.9
Median: 17.5 Median: 21.5
Last SHIM score Mean: 11.8 Mean: 14.23 (before Tx)
Median: 13 Median: 20

AS = active surveillance; PSA = prostate-specific antigen; Tx = treatment; N/A = not available; SHIM = Sexual Health Inventory for Men.

References in context

  • The mean follow-up for the cohort was 44 mo (median: 32; range: 12–208; Table 1).
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  • The mean age of the treated population at diagnosis was 65.3 yr of age; the mean PSA level (at diagnosis) was 5.66 ng/ml (Table 1).
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Table 2 Results following total prostatectomy of treated active surveillance patients

Gleason score at Tx Volume, % EPE SVI Margin BCR Follow-up, mo
3 + 4 15 − − + − 37
3 + 4 16 − − − − 24
3 + 3 1.5 − − + − 37
3 + 3 6 − − − − 37
3 + 4 3 − − − − 32
3 + 3 2.5 − − − − 47
4 + 3 6+ − − − − 32
3 + 4 20 + − − − 16
3 + 4 10 − − − − 29
4 + 4 1 − − − − 20
3 + 5 15 − − − − 2
3 + 4 − − − + − 2

Tx = treatment; EPE = extraprostatic extension; SVI = seminal vesical invasion; BCR = biochemical recurrence.

References in context

  • Seven patients treated with TP had Gleason score 3+4 or 4+3 on the TP specimen; two had Gleason score 3+5 or 4+4 (Table 2).
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Table 3 Decline in erectile function in different age groups

Age group, yr No. p value (first SHIM/last SHIM) Follow-up, mo
Group I: 40–49 12 p ≤ 0.019 (20/11.2) Mean: 36
Median: 27
Group II: 50–59 41 p = 0.376 (18.1/17) Mean: 42
Median: 30.5
Group III: 60–69 65 p ≤ 0.10 (13.5/10.7) Mean: 40.6
Median: 31.50
Group IV: 70–79 19 p ≤ 0.032 (12.2/9.2) Mean: 47
Median: 38.05

SHIM = Sexual Health Inventory for Men.

References in context

  • The significant increase in ED was seen in three of four age groups (40–49; 50–59; 60–69; 70–79; Table 3).
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  • The median follow-up was <3 yr; thus, age may not be the significant factor that affects ED in this AS cohort (Table 3).
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