title: PSA doubling time predicts the outcome after active surveillance in screening-detected prostate cancer: results from the European randomized study of screening for prostate cancer, Sweden section.
abstract: This study reports the outcome of active surveillance in men with PSA screening-detected prostate cancer (PC), and PSA doubling time (PSADT) was evaluated as a predictor of selecting patients to active treatment or surveillance. On December 31, 1994, 10,000 men were randomized to biennial PSA testing. Through to December 2004, a total of 660 men were diagnosed with PC, of whom 270 managed with initial surveillance. Of these 270 patients, 104 (39%) received active treatment during follow-up, 70 radical prostatectomy, 24 radiation and 10 endocrine treatment. Those who received active treatment during follow-up (mean 63 months) were significantly younger (62.6 vs. 65.5 years, p < 0.0001) and had a shorter PSADT (3.7 vs. 12 years, p < 0.0001). PSA relapse was observed in 9 of 70 patients who received RRP during a mean follow-up of 37 months. Seven of these nine PSA relapses were in the patients with preoperative PSADT < 2 years. None of the 37 operated patients with a PSADT > 4 years had a PSA relapse. In a Cox regression analysis adjusted for PSA, ratio-free PSA and amount of cancer in biopsy, only the preoperative PSADT was statistically significant predictor of PSA relapse in p = 0.031. The optimal candidate for surveillance is a man with early, low-grade, low-stage PC and a PSADT > 4 years. In younger men with a PSADT of less than 4 years, surveillance does not seem to be a justified alternative, and patient should be informed about the risk with such an approach.
authors.affiliation: Department of Urology, Sahlgrenska University Hospital, Gothenburg, Sweden. ali.khatami@urology.gu.se
authors.forename: Ali
authors.initials: A
authors.lastname: Khatami
authors.forename: Khatami
authors.initials: K
authors.lastname: Ali
authors.forename: Gunnar
authors.initials: G
authors.lastname: Aus
authors.forename: Aus
authors.initials: A
authors.lastname: Gunnar
authors.forename: Jan-Erik
authors.initials: JE
authors.lastname: Damber
authors.forename: Damber
authors.initials: D
authors.lastname: Jan-Erik
authors.forename: Hans
authors.initials: H
authors.lastname: Lilja
authors.forename: Lilja
authors.initials: L
authors.lastname: Hans
authors.forename: Pär
authors.initials: P
authors.lastname: Lodding
authors.forename: Lodding
authors.initials: L
authors.lastname: Pär
authors.forename: Jonas
authors.initials: J
authors.lastname: Hugosson
authors.forename: Hugosson
authors.initials: H
authors.lastname: Jonas
mesh_terms: D000368:Aged; D014408:Biomarkers, Tumor / Q000097:blood*; D006728:Hormones / Q000627:therapeutic use; D006801:Humans; D008297:Male; D008403:Mass Screening; D008875:Middle Aged; D011159:Population Surveillance; D017430:Prostate-Specific Antigen / Q000097:blood*; D011471:Prostatic Neoplasms / Q000097:blood* / Q000188:drug therapy / Q000532:radiotherapy; D011829:Radiation Dosage; D012307:Risk Factors; D013548:Sweden / Q000453:epidemiology; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D014408:Biomarkers, Tumor; D006728:Hormones; D017430:Prostate-Specific Antigen