Delayed therapy with curative intent in a contemporary prostate cancer watchful-waiting cohort.
OBJECTIVE
To identify predictors of delayed therapy with curative intent, an increasingly common option in contemporary patients with prostate cancer who initially choose watchful waiting.


METHODS
The characteristics of all patients at one institution and diagnosed with T1-4NXM0 prostate cancer between 1993 and 2000 were prospectively recorded. Factors recorded included: age, tumour stage, histological type, Gleason score, serum prostate specific antigen (PSA) level, prostate volume, PSA density (PSAD), percentage of positive biopsy cores, and the initial treatment selection. Outcomes, including all cancer-directed interventions, all serum PSA values, and initial outcomes of all interventions with curative intent, were determined by review of all medical records and cancer registry data.


RESULTS
Of 187 patients on watchful waiting, 175 had stage T1 or T2 cancer and were analysed primarily. Thirty-eight (22%) of these patients received delayed intervention with curative intent (15 radical prostatectomy, 17 external beam radiotherapy, six brachytherapy). Age (P < 0.001) and percentage of positive biopsy cores (P = 0.042) were significant independent predictors of intervention with curative intent. When the PSA doubling time was added to the model it became a significant predictor (P = 0.018), with percentage positive biopsy cores (P = 0.022) and age (P < 0.001).


CONCLUSIONS
Therapy with curative intent is common in contemporary patients with prostate cancer who initially choose watchful waiting. Age and percentage positive biopsy cores are independent predictors of such intervention, with PSA doubling time also an independent predictor.
el-Geneidy
M
M
Oregon Health & Science University, Department of Medicine, Division of Hematology & Medical Oncology, Oregon, USA.
Garzotto
M
M
Panagiotou
I
I
Hsieh
Y C
YC
Mori
M
M
Peters
L
L
Klein
T
T
Beer
T M
TM
D000230:Adenocarcinoma / Q000628:therapy*; D000368:Aged; D001706:Biopsy / Q000379:methods; D015331:Cohort Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011467:Prostate / Q000473:pathology; D017430:Prostate-Specific Antigen / Q000097:blood; D011468:Prostatectomy / Q000379:methods; D011471:Prostatic Neoplasms / Q000097:blood / Q000628:therapy*; D013997:Time Factors
D017430:Prostate-Specific Antigen