UROLOGICAL ONCOLOGY

Predictive factors for progression in patients with clinical stage T1a prostate cancer in the PSA era
Descazeaud A, Peyromaure M, Salin A, Amsellem-Ouazana D, Flam T, Viellefond A, Debré B, Zerbib M
Department of Urology, Cochin Hospital, Paris, France
Eur Urol. 2008; 53: 355-61

• Objective: In the literature, most data regarding the outcome of patients with clinical stage T1a prostate cancer were established before the prostate-specific antigen (PSA) era. The aim of our study was to determine the predictive factors of progression in patients with T1a prostate cancer diagnosed in the PSA era.
• Methods: Consecutive patients (n=144) with newly diagnosed T1a prostate cancer (tumor involving < or =5% of the resected prostatic tissue) were included. None of them was treated before evidence of tumor progression confirmed by prostate needle biopsies. The associations between tumor characteristics and time to cancer progression were assessed using Cox regression analysis.
• Results: With a mean follow-up of 5.1 yr, 30 patients (21%) experienced cancer progression. Five adverse parameters were significantly associated with cancer progression: preoperative PSA> or =10 ng/ml, postoperative PSA> or =2 ng/ml, prostate weight > or =60 g, weight of resected tissue > or =40 g, and Gleason score> or =6. The 5-yr progression rate was 12% if fewer than two of these parameters were present, whereas it was 47% if two or more parameters were present (p<0.001).
• Conclusion: In the PSA era the risk of progression associated with T1a prostate cancer can be predicted using five criteria, and two groups of patients can be defined. The patients at low risk of progression may be good candidates for surveillance. In those with a high risk of progression, a more aggressive treatment should be discussed.

• Editorial Comment
  Therapeutic options in pT1a prostate cancer vary from watchful waiting to immediate radical therapy. Because of (sometimes falsely) pathologically confirmed small tumor volume, conservative follow-up is not uncommon. These autors report on the clinical course of 144 patients with pT1a prostate cancer. This cohort is impressively low-risk with 71% Gleason score smaller or equal to 5. Still, a 25% 5 year progression rate was observed. The relative risk (RR) was increased in patients with initial PSA > 10 (RR 3.3, 40 % 5-year progression rate), Gleason score 6 or more (RR 2, 54 % 5-year progression rate) or postoperative PSA > 2 (RR 3.2, 44 % 5-year progression rate).
  These figures caution anyone to recommend watchful waiting if more than 1 risk factor is involved.

Dr. Andreas Bohle
Professor of Urology
HELIOS Agnes Karll Hospital
Bad Schwartau, Germany
E-mail: boehle@urologie-bad-schwartau.de