Audit of Patient Selection and Protocols for Prostate Cancer Active Surveillance in South Australia (#190)
Prostate cancer treatment with Active Surveillance (AS), is a protocol based treatment to try defer therapy and its concomitant side effects, in patients who are candidates for radical treatment.
There are a number of AS regimens, including those described by Klotz (2002) and the Prostate Cancer Research International: Active Surveillance (PRIAS) trial, generally Gleason 6, PSA <10 and 1 or 2 cores positive for cancer.
This study assess the selection criteria and monitoring of patients with PSA and repeat biopsies, to assess AS administered in a public hospital setting.
Outpatient letters from the Repatriation General Hospital and Royal Adelaide Hospital from 2005 to 2013 were screened for the phrase ‘active surveillance’. Letters were manually reviewed to confirm patients were on active surveillance for prostate cancer.
Exclusion criteria included:
· Active surveillance for other conditions
· Patients in whom AS was discussed but decided to have definitive surgery or radiotherapy instead.
The SA-PCCOC database was utilised to extract patient demographics, prostate biopsy and PSA results, occurence of radiotherapy or radical prostatectomy.
144 patients were identified as being on AS.
Mean age and PSA at time of diagnosis was 67.5 years (49-85) and 7.1 (0.6-39), 31 patients PSA >10
Gleason Score at diagnosis:
· Gleason 4-5: 7
· Gleason 6: 117
· Gleason 7: 14
· Gleason 8-9: 2
· Missing Data: 4
Mean Number of TRUS biopsies performed 2 (Range 1-5).
Active Surveillance is an expectant management protocol and variations can occur based on individual clinician and patient discussions.
In this cohort, the majority of patients had Gleason 6 disease, PSA <10. However there were a number of patients in whose biopsy, PSA and age parameters did not fit with current protocols.
There was no differentiation made between level of clinician (Registrar vs Consultant) dictating the letter, which may influence the results of this study.