title: Predictors of delayed therapy after expectant management for localized prostate cancer in the era of prostate-specific antigen.
abstract: OBJECTIVE
  To identify risk factors for delayed cancer-directed intervention in modern era prostate cancer patients who initially elect expectant management.
  
  
  METHODS
  An observational, cohort study of expectantly managed patients, diagnosed with clinical T(1-4)NxM0 prostate cancer between 1993 and 2000 was carried out. Data including TNM stage, age, serum prostate-specific antigen (PSA), prostate gland volume by transrectal ultrasound, Gleason score, percent biopsies positive for cancer, imaging results, initial treatment selection, and outcome data were collected on all patients.
  
  
  RESULTS
  192 of 561 patients (34.3%) elected expectant management, and follow-up data were available for 187 (97.4%) patients. With a median follow-up of 3.6 years, 90 (48.1%) patients had a cancer-directed intervention. Gleason score (p = 0.0097) and percent of positive biopsy cores (p = 0.03) were independent predictors of time to intervention. As expected, PSA doubling time became the most significant predictor of intervention (p = 0.0057) when added to the model. These independent covariates are able to characterize low-, intermediate- and high-risk groups for cancer-directed intervention.
  
  
  CONCLUSIONS
  Cancer-directed intervention is common in patients who choose expectant management in the PSA era. Gleason score and percent of positive biopsy cores predict cancer-directed interventions, thus, these patients may be least suitable for expectant management.
authors.affiliation: Division of Hematology and Medical Oncology, Cancer Institute, Oregon Health and Science University, Portland, OR, USA.
authors.forename: Irene
authors.initials: I
authors.lastname: Panagiotou
authors.forename: Tomasz M
authors.initials: TM
authors.lastname: Beer
authors.forename: Yi-Ching
authors.initials: YC
authors.lastname: Hsieh
authors.forename: Motomi
authors.initials: M
authors.lastname: Mori
authors.forename: Laura
authors.initials: L
authors.lastname: Peters
authors.forename: Thomas
authors.initials: T
authors.lastname: Klein
authors.forename: Mark
authors.initials: M
authors.lastname: Garzotto
mesh_terms: D000230:Adenocarcinoma / Q000276:immunology / Q000473:pathology / Q000628:therapy*; D000704:Analysis of Variance; D015331:Cohort Studies; D006801:Humans; D008297:Male; D009367:Neoplasm Staging; D019370:Observation; D011237:Predictive Value of Tests; D017430:Prostate-Specific Antigen / Q000097:blood*; D011471:Prostatic Neoplasms / Q000276:immunology / Q000473:pathology / Q000628:therapy*; D012307:Risk Factors; D016019:Survival Analysis; D013997:Time Factors
chemical_list: D017430:Prostate-Specific Antigen