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Presented: R Phillips YUAG November 2011 NJ Smith,SK Sundaram , PMT Weston R Chahal

Does following NICE guidelines for active surveillance of low-risk prostate cancer result in only short-term freedom from radical intervention?. Presented: R Phillips YUAG November 2011 NJ Smith,SK Sundaram , PMT Weston R Chahal Pinderfields Hospital, Wakefield.

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Presented: R Phillips YUAG November 2011 NJ Smith,SK Sundaram , PMT Weston R Chahal

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  1. Does following NICE guidelines for active surveillance of low-risk prostate cancer result in only short-term freedom from radical intervention? Presented: R Phillips YUAG November 2011 NJ Smith,SKSundaram, PMT Weston R Chahal Pinderfields Hospital, Wakefield

  2. Active Surveillance NICE Guidelines (February 2008) • Active surveillance (AS) is the preferred option for men with low risk Ca who would be considered for radical treatment • Low risk = PSA <10ng/ml, and Gleason score ≤ 6 and • Clinical stageT1-T2a • Particularly • PSA density <0.15ng/ml/ml • Ca in <50% total number cores • <10mm in any 1 core • At least 10 biopsy cores taken • Should have at least 1 re-biopsy in accordance with ProSTART protocol • Rpt biopsy at 1st and 3rd anniversary • DRE + PSA every 3 months for 2 years

  3. Aim/Methods: • Are we adhering to NICE guidelines in enrolling patients onto an AS programme? • Do patients attend follow-up as stated by the guidelines? • What proportion of patients continue on AS, and what are the reasons why patients are taken off AS? • Retrospective data collection April 2008 to April 2010 • Patients identified from MDT lists

  4. 60 patients, mean age 63.2 yrs 87% low risk 75% didn’t fulfill more stringent NICE criteria Results Reasons criteria not met 60% % 13% 2%

  5. PSA Density • Mean PSAD for 54/60 patients = 0.18 • Median = 0.17 • Mean PSAD for patients who had RRP or EBRT (n=18) = 0.20 • Median = 0.2 • Mean PSAD for those continuing AS = 0.17 (n=33) • Median = 0.17 • Mean PSAD if upgraded at re-biopsy = 0.231 if not-upgraded at re-biopsy mean PSAD = 0.171 p=0.07 (unpaired T-test with Welch correction).

  6. Follow Up 95% Patients had DRE at 1st clinic appointment 1 Patient has serial DRE (3 consecutive clinic appointments)

  7. Outcome • Median follow-up on AS = 15.5 months (range 0-36) 23% 55% 7% 12%

  8. Conclusion Patient selection for AS didn’t follow the strict NICE guidelines in 75% cases (mainly due to PSA density). However, 87% were low-risk prostate cancers. We don’t take into account PSA density when enrolling patients onto AS. At 24 months follow-up 55% still on AS. This figure is lower than the main published AS series. Due to higher rates of both upgrading at re-biopsy and patient choice for radical treatment. Patients seen every 3-4 monthly for first year then average 6 monthly. Although clinic appointments are not always on time, most patients get the repeat biopsy on time.

  9. Questions?

  10. Radical Prostatectomies

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