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Treatment Selection Following Conservative Management of Localized Prostate Cancer
Kristen R. Scarpato, MD, MPH, Rachael Sussman, BA, Peter C. Albertsen, MD, MS.
University of Connecticut, Farmington, CT, USA.
INTRODUCTION:
Some men diagnosed with localized, low grade prostate cancer elect conservative management as their initial treatment option. As time progresses, some patients become anxious with their decision while others become very comfortable. To gain insight into patient choices, we conducted a retrospective analysis of patients initially electing active surveillance or watchful waiting over the past fifteen years.
METHODS:
An IRB approved retrospective chart review of 160 men from a prospectively managed database was performed. Patient characteristics including age at diagnosis, Charlson comorbidity index (CMI), prostate specific antigen (PSA) value, and Gleason grade were recorded. Those who chose to abandon conservative management were reviewed including their reasons for electing treatment, as well as timing of therapy and specific treatment modality chosen.
RESULTS:
The mean age at diagnosis was 67.5 years with one half of patients falling between 61-74 years. Sixty-four percent had no co-morbidities and 24% had just 1. The majority of the patients (77%) had Gleason Grade 3+3=6 disease on original biopsy. A total of 46 patients elected to undergo treatment within 15 years of diagnosis. Patient selections included with surgery, radiation, or hormonal therapy based upon patient anxiety, increasing tumor volume, Gleason upgrading or rising PSA values.values. During the first 7.5 years of follow up, patients were more likely to elect surgery or radiation (92%), when compared to those who were followed longer. Patients treated conservatively for more than 7.5 years were more likely to request anti-androgen therapy (64 xx%) than aggressive treatment.
CONCLUSION:
Patients who are comfortable being managed conservatively for low grade prostate cancer are more likely to opt for anti-androgen therapy and less likely to choose surgery or radiation therapy when and if they experience signs of disease progression.
Table One: Treatment Selection According to Years of Follow Up | | | | | | Follow Up (years) | Radical Prostatectomy | Radiation Therapy | Hormonal Therapy | Total | | 0-7.5 | 13 (54%) | 9(38%) | 1(4%) | 24* | | 7.6-15 | 5(23%) | 3(14%) | 14(64%) | 22 |
*One patient's treatment selection unknown
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