Can Active Surveillance Be Extended To Some Men With Elevated PSAs?

MedicalResearch.com Interview with:
Isaac Yi Kim, MD, PhD
Acting Chief and Associate Professor, Division of Urology
Rutgers Robert Wood Johnson Medical School
Chief, Section of Urologic Oncology and
Young Suk “Joseph” Kwon, MD
Post-doctoral fellow  Section of Urologic Oncology
Rutgers Cancer Institute of New Jersey
Rutgers, The State University of New Jersey
New Brunswick, NJ 08903

Medical Research: What is the background for this study?

Response: Although PSA < 10 ng/mL is a typically required condition under which many active surveillance (AS) protocols operate, this current guideline may predispose lower risk patients with incongruently elevated PSA to aggressive and potentially unnecessary therapies. Specifically, urologists infrequently encounter patients with PSA > 10 ng/ml but biopsy demonstrating a relatively lower risk prostate cancer (PCa).

Therefore, we wanted to test whether active surveillance may be a viable option in some men with a histologically favorable risk prostate cancer and serum PSA between 10 and 20 ng/ml.

Medical Research: What are the main findings?

Response: We compared oncologic outcomes in men with favorable biopsy histology and varying PSA levels: low, intermediate, and high PSA levels.

The rates of upstaging and upgrading were similar between the intermediate PSA (IP) (≥10 and 20) and low PSA (LP) (<10) group. In contrast, the high PSA  (HP) (≥20) group had higher incidences of both upstaging (p=0.02) and upgrading to ≥4+3 (p=0.046) compared to the IP group. BCR-free survival rates revealed no pair-wise inter-group differences, except between low PSA and high PSA .

Medical Research: What should clinicians and patients take away from your report?

Response: Those with isolated elevation of preoperative PSA levels between 10 and 20 ng/ml who are otherwise considered to have a histologically favorable risk prostate cancer are not at a higher risk of having adverse pathologic and oncologic outcomes when compared to those who qualify for active surveillance. Therefore, active surveillance may be extended to carefully selected individuals with incongruently elevated PSA levels between 10-20 ng/ml.

Medical Research: What recommendations do you have for future research as a result of this study?

Response: Large-scale prospective randomized clinical trials with a longer follow-up period are necessary to validate our study findings for clinical application.

Citation:

Pathological Outcome Following Radical Prostatectomy in Men with PSA Greater than 10 and Histologically Favorable-Risk Prostate Cancer. 

Yu, Jiwoong et al. The Journal of Urology

DOI: http://dx.doi.org/10.1016/j.juro.2015.11.031

Isaac Yi Kim, MD, PhD, & Young Suk “Joseph” Kwon (2015). Can Active Surveillance Be Extended To Some Men With Elevated PSAs? 

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