What percentage of patients with newly diagnosed carcinoma of the prostate are candidates for surveillance? An analysis of the CaPSURE database.
OBJECTIVE
Active surveillance is an option for men with clinically localized prostate cancer and may be suitable for those with very low risk disease. We determined the percentage of men in a large prostate cancer registry who met criteria predictive of latent prostate cancer. We also assessed the percentage of men meeting these criteria who chose surveillance.


METHODS
We conducted an observational study of 1,886 men diagnosed with clinically localized prostate cancer between 1999 and 2004 from the CaPSURE database. Outcomes were percent of men meeting Epstein surveillance criteria (prostate specific antigen less than 10 ng/ml, clinical T1 or T2a, prostate specific antigen density less than 0.15, fewer than 1 of 3 biopsy cores positive, and absence of Gleason pattern 4 and 5 on biopsy) and percent selecting surveillance stratified by risk group.


RESULTS
Of 1,886 men with all 5 criteria documented 16.4% (310 of 1,886) met all 5 surveillance criteria and 9.0% (28 of 310) of men in this very low risk category actually chose surveillance compared with 4.3% (68 of 1,576) of patients in other risk groups (p <0.01). On multivariable analysis of the entire cohort older age was the only demographic predictor of surveillance. Being in the very low risk group was also a predictor of surveillance.


CONCLUSIONS
Of men presenting with localized prostate cancer 16% met the criteria for very low risk disease. However, only a small subset of eligible men chose active surveillance, suggesting that it may be underused in the management of very low risk prostate cancer.
Barocas
Daniel A
DA
Department of Urologic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA.
Cowan
Janet E
JE
Smith
Joseph A
JA
Carroll
Peter R
PR
D000230:Adenocarcinoma / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy*; D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D001707:Biopsy, Needle; D016009:Chi-Square Distribution; D006801:Humans; D007150:Immunohistochemistry; D015994:Incidence; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D008991:Monitoring, Physiologic / Q000379:methods*; D015999:Multivariate Analysis; D009364:Neoplasm Recurrence, Local / Q000453:epidemiology / Q000473:pathology*; D009367:Neoplasm Staging; D019370:Observation / Q000379:methods; D018579:Patient Selection; D011379:Prognosis; D017430:Prostate-Specific Antigen / Q000097:blood*; D011471:Prostatic Neoplasms / Q000175:diagnosis* / Q000453:epidemiology / Q000628:therapy*; D012042:Registries; D012189:Retrospective Studies; D018570:Risk Assessment; D016019:Survival Analysis; D016896:Treatment Outcome
D017430:Prostate-Specific Antigen