Gleason score 7 screen-detected prostate cancers initially managed expectantly: outcomes in 50 men
Article first published online: 19 JAN 2009
© 2009 THE AUTHORS. JOURNAL COMPILATION © 2009 BJU INTERNATIONAL
Volume 103, Issue 11, pages 1472–1477, June 2009
How to Cite
Van Den Bergh, R. C.N., Roemeling, S., Roobol, M. J., Aus, G., Hugosson, J., Rannikko, A. S., Tammela, T. L., Bangma, C. H. and Schröder, F. H. (2009), Gleason score 7 screen-detected prostate cancers initially managed expectantly: outcomes in 50 men. BJU International, 103: 1472–1477. doi: 10.1111/j.1464-410X.2008.08281.x
- Issue published online: 11 MAY 2009
- Article first published online: 19 JAN 2009
- Accepted for publication 1 October 2008
- active surveillance;
- prostate cancer;
- watchful waiting
To assess whether men newly diagnosed with Gleason 7 prostate cancer are eligible for active surveillance (AS) instead of radical treatment. AS is an appropriate initial strategy in selected men who are presently diagnosed with prostate cancer, as many tumours will not progress during a patient’s lifetime.
PATIENTS AND METHODS
Cancer-specific-, overall and treatment-free survival were analysed retrospectively in men with Gleason score 7 cancer who were initially managed expectantly. All were screen-detected in four centres of the European Randomized Study of Screening for Prostate Cancer.
In 50 men active therapy was initially withheld if they had Gleason 7 disease; 29 of 50 (58%) would otherwise have been suitable for AS, as they had a prostate-specific antigen (PSA) level of ≤10.0 ng/mL, a PSA density of <0.2 ng/mL/mL, stage T1c/T2, and two or fewer positive biopsy-cores; 44 of 50 (88%) had a Gleason score 3 + 4 = 7. The mean (range) age of the men was 69.5 (59.6–76.2) years and the median (interquartile range) follow-up was 2.6 (0.8–5.0) years; the mean American Society of Anesthesiologists score was 1.8. The 6-year cancer-specific survival (nine patients at risk) was 100%, which sharply contrasted with the 68% overall survival. Men alive at the time of analysis had a favourable PSA level and PSA-doubling time. The 6-year treatment-free survival was only 59%, with most patients switching to active therapy, justified on the basis of their PSA level. However, men with otherwise favourable tumour characteristics and a Gleason score of 3 + 4 = 7 remained treatment-free significantly longer than their counterparts with unfavourable other tumour features and a Gleason score of 4 + 3 = 7.
In selected patients with screen-detected Gleason 3 + 4 = 7 prostate cancer, AS might be an option, especially in those with comorbidity and/or a short life-expectancy.