Among prostate cancers that are judged to be low risk after physical exam and biopsy, and which thus are candidates for active surveillance, 33%-45% are upgraded or upstaged when the patient decides instead to undergo radical prostatectomy, according to a report in the February issue of Journal of Urology.
Researchers analyzed data regarding tumor and patient features for 4,500 cases in a national Swedish database of prostate cancers diagnosed during a 4-year period. All of these cases were judged to be low risk on the basis of Gleason scores, PSA findings, and biopsy results, but all of the men elected to undergo radical prostatectomy, said Dr. Annelies Vellekoop of New York University and Manhattan Veterans Affairs Medical Center, New York, and her associates.
Even though these cases met stringent criteria for active surveillance according to several different protocols, 33%-45% of them (depending on the protocol) were found at surgery to have adverse pathology signaling that the cancers were of higher risk than anticipated (J. Urol. 2014;191:350-7).
Three predictors of upstaging/upgrading – age over 60 years, high PSA level, and stage T2 cancer on biopsy – are already known to raise risk and are included in most risk-assessment criteria. But two other factors – PSA density greater than 0.15 ng/mL and the linear extent of cancer in mm within biopsy specimens – were found to be highly predictive in this study and should be considered as additional criteria to include in risk assessments, the investigators said.
This study was supported by the Swedish Research Council, the Swedish Cancer Foundation, Vasterbotten County Council, and Lion’s Cancer Research Foundation at Umea University. Dr. Vellekoop reported no financial conflicts of interest; one of her associates reported ties to Sanofi.