AI Article Synopsis

  • There is concern about over-treatment in young men (≤55 years) diagnosed with prostate cancer, as 45% of these cases are classified as very low risk, yet most receive active treatment despite favorable outcomes.
  • The study identified young men as potential candidates for active surveillance (AS) rather than immediate treatment, particularly those with specific low-risk cancer characteristics.
  • Analysis of data from servicemen revealed a significant increase in PSA-detected prostate cancer cases over time, with a large proportion of those diagnosed opting for treatment despite having favorable pathology.

Article Abstract

Unlabelled: WHAT'S KNOWN ON THE SUBJECT? AND WHAT DOES THE STUDY ADD?: Little is known as to the potential for over-treatment of young men diagnosed with prostate cancer. We show that for men aged ≤55 years with PSA screen-detected disease, 45% of the tumours are classified as very low risk and 85% of these have favourable pathology, yet most are actively treated. These findings raise the spectre of over-treatment for a group of men likely to be affected by treatment side-effects.

Objective: To identify a population of young men (aged <55 years at diagnosis) with very-low-risk prostate cancer (stage cT1c, with prostate-specific antigen [PSA] density of <0.15 ng/mL/g, Gleason score ≤6, and ≤2 positive biopsy cores with <50% tumour involvement) that may be candidates for active surveillance (AS).

Patients And Methods: We queried a Department of Defense tumour registry and hard-copy records for servicemen diagnosed with prostate cancer from 1987 to 2010. Statistical analyses were undertaken using Fisher's exact and chi-square testing.

Results: From 1987-1991 and 2007-2010, PSA screen-detected tumours diagnosed in men aged ≤55 years rose >30-fold. Data for a subset of men (174) with PSA screen-detected cancer were evaluable for disease risk assessment. Of the 174 men with screen-detected disease, 81 (47%) had very-low-risk disease. Of that group, 96% (78/81) selected treatment and, of 57 men undergoing radical prostatectomy (RP), the tumours of 49 (86%) carried favourable pathology (organ confined, <10% gland involvement, Gleason ≤6).

Conclusions: Nearly half of young men with PSA screen-detected prostate cancer are AS candidates but the overwhelming majority seek treatment. Considering that many tumours show favourable pathology at RP, there is a possibility that these patients may benefit from AS management.

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Source
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3637421PMC
http://dx.doi.org/10.1111/j.1464-410X.2012.11768.xDOI Listing

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