Contemporary Management of Prostate Cancer at an Australian Tertiary Referral Centre — YRD
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  3. Contemporary Management of Prostate Cancer at an Australian Tertiary Referral Centre

Contemporary Management of Prostate Cancer at an Australian Tertiary Referral Centre (#120)

Prassannah Satasivam 1 , Sareetaa Vijayan , Mark Frydenberg , Sree Appu
  1. Monash Health, Melbourne

Background/significance:

Active surveillance (AS) has emerged as a safe alternative to radical prostatectomy (RP) and primary radiotherapy (XRT) for the treatment of low-risk prostate cancer.

Objectives:

This study sought to examine whether clinical practice at our institution reflected the emerging evidence.

Methods:

We retrospectively reviewed 409 consecutive TRUS-guided prostate biopsies performed between May 2010 and April 2013 at Monash Health, Melbourne. Patients with positive biopsies were stratified according to the D’Amico risk classification and treatment decisions compared using Chi-square analysis. Regression analysis was applied to 62 consecutive RPs performed during the same period to identify trends in the distribution of surgeries performed for each risk category. Statistical significance was specified as p < 0.05.

Results:

Patients undergoing TRUS biopsy had a mean age of 63 years and median PSA of 7.55 μg/L. Fifty percent (n=205) had positive biopsies, of whom 84 were subsequently classified as low-, 80 as intermediate- and 41 as high-risk according to the D’Amico criteria. On multivariate analysis, age > 65 years (p < 0.001) and D’Amico classification (p < 0.001) significantly predicted the choice of treatment modality. 37% of patients undertaking AS were over 65 years, compared with 22% of patients undergoing RP and 69% of those having XRT. Surveillance was chosen by 78% of low-risk and 26% of intermediate-risk patients. XRT was chosen by 9%, 36% and 50% of low-, intermediate- and high-risk patients respectively. RP was undertaken in 11%, 32% and 13% of low-, intermediate- and high-risk patients respectively. The rate of RP for low-risk disease fell from 50% of cases in the latter half of 2010 to none in early 2013 (p = 0.009 for trend). Conversely, the percentage of RP for intermediate-risk disease rose from 38% to 75% (p = 0.02).

Conclusion:

Increasing acceptance of AS has led to its widespread use in younger men and a reduction in surgery performed for low-risk disease at our institution.