Watchful Waiting Management for Prostate Ca a Hard Sell

ORLANDO—Men with indolent, very-low-risk prostate cancer who are eligible to be managed with active surveillance or "watchful waiting" appear to be reluctant to choose this strategy, researchers said at ASCO's 2007 Prostate Cancer Symposium (abstract 292). Only 28 of 310 men (9%) who were candidates for surveillance opted for surveillance, Daniel A. Barocas, MD, chief resident in urology at New York-Presbyterian Hospital-Weill Cornell Medical College, said at a press briefing at the symposium.

Dr. Barocas and his colleagues analyzed data from the CaPSURE database, a longitudinal, observational prostate cancer registry. Of the 1,886 men in the registry diagnosed between 1999 and 2004 for whom adequate data were available, 310 were classified as very low risk.

Lowest risk criteria were PSA less than 10 ng/mL at diagnosis, no Gleason pattern 4 or 5 on biopsy, stage T1 or T2a, PSA density less than 0.15, and fewer than 33% of cores positive on biopsy. "The percentage of men meeting lowest-risk disease criteria ranged from 14% to 17%, depending on the year, but there was no significant trend over time," he said.

The patients who were lowest risk and met the criteria for surveillance were significantly more likely to be younger and white and to have more education, higher income, and private insurance. "This corroborates prior findings and suggests there may be disparities in access to early detection programs," Dr. Barocas said.

Men were more likely to opt for active surveillance if they were older, had a PSA less than 10 ng/mL, and were without high-grade disease. "Men aged 63 to 70 years were 5 times more likely to choose surveillance than men younger than 63, and men over age 70 were 26 times more likely to choose surveillance than men younger than age 63," Dr. Barocas said.

With 16% of the registry patients meeting the criteria predicting indolent disease, but just 9% of eligible patients opting for surveillance, the possibility of overtreatment has been raised, Dr. Barocas said. "Active surveillance may be an underutilized strategy for managing very-low-risk prostate cancer. Patients should talk to their doctors about their risk category and whether they are candidates for this approach," he said.