Prostate news article, March 2006
| PROGRESSION-FREE
SURVIVAL RATES IN MEN TREATED WITH RADICAL PROSTATECTOMY DIAGNOSED
USING A CUTOFF POINT OF 2.6nG/ml
Jang TL, Han M, Roehl KA, Hawkins SA, Catalona WJ Article in Urol 2006; 67:343-348 |
Approximately 20% of men undergoing prostate biopsy having a screening PSA between 2.6ng/ml and 4.0ng/ml are found to have prostate cancer (CaP). In 1995 Dr Catalona and coworkers changed their screening PSA cutoff point from 4.0ng/ml to 2.6ng/ml. They analyzed the differences in clinical and pathologic stage and progression-free survival (PFS) in the higher (4.0ng/ml, group 1) and lower (2.6ng/ml, group 2) cohorts of these men. The report by Dr. Jang and associates appears in the February 2006 issue of Urology.
Men prior to 1995 had a 4-sector prostate biopsy for a PSA >4.0ng/ml. After 1995 men with a PSA >2.6ng/ml had a 6-sector prostate biopsy. In group 1, 1,141 men who underwent RP were compared to 1,100 men in group 2 who had RP. PSA was serially followed and recurrence defined as a PSA post surgery >0.2ng/ml.
The percentage of patients with stage T1c CaP increased from 45% in group 1, to 80% in group 2. The proportion of men with Gleason score <6 increased from 19% to 52% in groups 1 and 2 respectively. The percentage of men with Gleason score 2-4 and Gleason 8-10 decreased from 16% to 2.2% and 7% to 3.3% respectively from the pre 1995 and post 1995 eras.
Organ confined CaP was pathologically found in 69% of group 1 and 75% of group 2 men, which was also statistically significant. Group 2 had statistically improved PFS rates 5 and 8 years after RP, although the exact numerical difference is not reported in the paper. There was not an increase in the percentage of men who were found to have insignificant CaP pathologically, which was defined as organ confined, tumor smaller than 0.5cm3, and absence of Gleason grade 4 or 5.
Multivariate modelling demonstrated that pre-op PSA, clinical stage and Gleason score were independently associated with biochemical progression. However, when controlling for these factors in the model, no difference in the risk of PSA progression was found. The authors suggest that the era is a surrogate measure for other predictive clinical and pathological parameters. They also point out that improvements in surgical technique, and length and lead-time biases may influence the reported results.
By Christopher P. Evans, M.D.
Urol 2006; 67:343-348