Expectant Management of Prostate Cancer. James A. Eastham, MD and Peter T. Scardino, MD June 23, 2010 Presented by: K. Witzke, DO. Background.
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James A. Eastham, MD and Peter T. Scardino, MD
June 23, 2010
Presented by: K. Witzke, DO
Active Surveillance Watchful Waiting
Aim To individualize treatment To avoid treatment
Fit for radical treatment Age >70 yr or life expectancy <15 yr
Age 50-80 yr
T1-T2, GS ≤7, initial PSA <15 ng/mL Any T stage, GS ≤7, any PSA
Monitoring Frequent PSA testing PSA testing unimportant
Repeated biopsies No repeated biopsies
Indications for treatment
Short PSADT Symptomatic progression
Higher grade or more extensive cancer on biopsy
Treatment timing Early Delayed
Treatment intent Radical Palliative
Gleason Sum 50-59 60-64 65-69 70-74
2-4 4% 5% 6% 7%
5 6% 8% 10% 11%
6 18% 23% 27% 30%
7 70% 62% 53% 42%
8-10 87% 81% 72% 60%
Physician: Locates the patients PSA on PRETX PSA axis, draw line upward to the points axis (points toward have indolent cancer). Repeat this process for remaining axes. Add the points locate on Total Points axis. Draw a line down to probability of having indolent cancer.
1 Point 2 Points 3 Points
Gleason score increase 1 >1 Any new Gleason pattern 4 or 5
PSA velocity (ng/mL/yr) >0.75 during 12 months >0.75/yr during 24 months
Increasing old lesion
New lesion not biopsy proven New biopsy- proven lesion
Biopsy specimens Bilateral or multifocal cancer >4 cores with cancer
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