Reply from authors re: Stacy Loeb. Does delaying prostate cancer treatment miss the window of curability? Eur Urol 2013;64:216-7: Risk management and individualisation for active surveillance

摘要

We would like to thank Loeb for the editorial comment [1] on our collaborative review [2]. Herein we respond to her remarks and present some additional considerations concerning treatment delay for prostate cancer (PCa) and the relationship with active surveillance (AS). The current methods of risk stratifying disease using pretreatment parameters are limited. Multiple studies have confirmed that even patients fulfilling the most strict criteria for AS can actually harbour clinically significant disease. Suardi et al. analysed the oncologic outcomes of men who received surgery but who also would have been suitable for AS based on the Prostate Cancer Research International Active Surveillance (PRIAS) study inclusion criteria; they found almost 6% with extracapsular extension and 28% with Gleason score >7 [3].