Predictors of delayed therapy after expectant management for localized prostate cancer in the era of prostate-specific antigen.
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.
Panagiotou
Irene
I
Division of Hematology and Medical Oncology, Cancer Institute, Oregon Health and Science University, Portland, OR, USA.
Beer
Tomasz M
TM
Hsieh
Yi-Ching
YC
Mori
Motomi
M
Peters
Laura
L
Klein
Thomas
T
Garzotto
Mark
M
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
D017430:Prostate-Specific Antigen