Summary of talk on Active Surveillance at current urology conference

[Guest guest]

The a presentation by Dr. Klotz, Sunnybrook, Toronto, is summarized

below on results of appopriately selected patients following Active

Surveillance (AS).

The referenced web site

PSAkinetics.sunnybrook.ca

has excellent information on the Sunnybrook practice of Active

Surveillance and includes an online program for assessing relative

risk of cancer progression while following AS.

As pointed out below, about a third of men following AS in the

Sunnybrook program decide at some point to move from AS to

treatment. However, a 'take home' message in this is that the

experience at Sunnybrook, as well as clinical AS centers in the U.S.

and Europe, demonstrates that their risk of cancer recurrence after

delayed treatment is virtually the same as if they had immediate

treatment. Meanwhile while deferring treatment they had none of the

potential quality of life impacts from treatment, and, the treatment

options improved in the interim.

The key, in my opinion as an AS patient, is to carefully assess

whether or not your cancer diagnostics suggest that AS is a viable

option FOR YOU, and, to do proactive monitoring while on AS.

The Best to You and Yours!

Jon in Nevada

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SUO 2008 - Update on Active Surveillance: Mini-symposium on Focal

Therapy - Session Highlights

Written by P. , MD Tuesday, 09 December 2008

BETHESDA, MD (UroToday.com) - Dr. Scardino introduced the

session on focal therapy for prostate cancer. He defined low-risk

prostate cancer and the excellent oncologic outcomes for this group

as a whole. While some low-risk patients turn out to have higher risk

features, this is presently rare and more commonly the pathologic

analysis reveals possibly very minimal disease. In this context, the

session addressed active surveillance (AS) and focal therapies.

Dr. ce Klotz addressed AS in prostate cancer. He initially

published a 7-year follow-up of almost 400 patients on AS.

Approximately one-third converted to active therapy at 7 years. He

provided follow-up on this cohort. In the CaPSURE database, 10% of

low-risk patients accept AS. In other published literature, assessing

1,833 patients in 6 cohorts, it appears that none address the number

of patients who are appropriate candidates for AS and who actually

undergo it. There are a variety of physician, patient, and social

factors that influence this. Educational aspects turn out to be less

influential in the Toronto database. He discussed the difference

between disease progression and the trigger for intervention. What

should be evaluated is the re-classification to a higher risk group,

he stated. Criteria for re-classification include a PSADT<3 years and

higher grade on biopsy. Mass spec and biomarkers may eventually

contribute to elucidating this. The website PSAkinetics.sunnybrook.ca

incorporates an AS nomogram that anyone can use to follow their AS

patients.

In the literature, about one-third of AS patients convert to

intervention within 10 years. The most common reason for conversion

to treatment was a PSADST<3 years in 13%, and grade progression is

6%. Patient preference accounted for 5%. Anxiety is not a common

variable if patients are appropriately reassured.

Dr. Klotz discussed the overall survival in 453 Toronto patients. The

OS is 70% at 10 years and only 5 deaths due to CaP. In only one

patient did an analysis reveal that he may have benefited from

initial treatment and not AS. Patients are more likely to die of

other causes. Patients who underwent active treatment were not found

to be at increased risk for treatment failure. A global START trial

will further help us understand AS and related outcomes.

Presented by ce Klotz, MD in a session moderated by

Scardino, MD at the 9th Annual Winter Meeting of the Society of

Urologic Oncology (SUO) - December 4 - 6, 2008 - Natcher Conference

Center, National Institutes of Health, Bethesda, land