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Takeshita N, Sakamoto S, Yamada Y, Sazuka T, Imamura Y, Komiya A, Akakura K, Sato N, Nakatsu H, Kato T, Sugimoto M, Tsuzuki T, Ichikawa T. Detection of intraductal carcinoma in prostate cancer patients with small tumor volume. Prostate 2023; 83:580-589. [PMID: 36762419 DOI: 10.1002/pros.24492] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2022] [Revised: 11/16/2022] [Accepted: 01/23/2023] [Indexed: 02/11/2023]
Abstract
OBJECTIVES The purpose of this study was to investigate intraductal carcinoma of the prostate (intraductal carcinoma) and significant cancer (SC) in patients with small tumor volume (<0.5 cm3 ) in prostatectomy specimens. METHODS Data from 639 patients undergoing radical prostatectomy between April 2006 and December 2017 at Chiba University Hospital and 2 affiliated institutions were retrospectively reviewed. Tumor volume in prostatectomy specimens was measured, and with a tumor volume of less than 0.5 cm3 , the presence of intraductal carcinoma and SC was examined. SC was defined as one that did not meet the definition of pathological insignificant cancer (organ-confined cancer, Grade Group 1, tumor volume < 0.5 cm3 ). The number of patients who met four active surveillance (AS) protocols was also examined. RESULTS A total of 83 patients with tumor volume < 0.5 cm3 were identified in this study population (SC: 43 patients [52%], intraductal carcinoma: 5 patients [6%]). The median follow-up was 34.6 months (range: 18-57 months). Four (5%) developed biochemical recurrence. The number of positive biopsy cores ≥ 2 was an independent predictor of SC in patients with tumor volume < 0.5 cm3 (hazard ratio: 4.39; 95% confidence interval: 1.67-11.56; p = 0.003). In tumor volume < 0.5 cm3 , tumor volume was significantly correlated with the International Society of Urological Pathology Grade Group (1 vs. 4-5, p = 0.002) and the presence of intraductal carcinoma (p = 0.004). In intraductal carcinoma-positive cases, four of five patients (80%) had the predictor of SC, which was two or more positive biopsy cores. Of the four AS protocols, the criteria for Prostate Cancer Research International: Active Surveillance were met most frequently in 46 cases (55%) of tumor volume less than 0.5 cm3 if targeted biopsy by magnetic resonance imaging was available. CONCLUSION The results of the present study suggest that intraductal carcinoma was present even in cases with small tumor volumes. Grade Group and intraductal carcinoma showed a positive correlation with tumor volume.
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Affiliation(s)
- Nobushige Takeshita
- Department of Urology, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Shinichi Sakamoto
- Department of Urology, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Yasutaka Yamada
- Department of Urology, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Tomokazu Sazuka
- Department of Urology, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Yusuke Imamura
- Department of Urology, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Akira Komiya
- Department of Urology, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Koichiro Akakura
- Department of Urology, Japan Community Health Care Organization, Tokyo, Japan
| | - Nobuo Sato
- Department of Urology, Funabashi Municipal Medical Center, Chiba, Japan
| | | | - Takuma Kato
- Department of Urology, Kagawa University Faculty of Medicine, Kagawa, Japan
| | - Mikio Sugimoto
- Department of Urology, Kagawa University Faculty of Medicine, Kagawa, Japan
| | - Toyonori Tsuzuki
- Department of Surgical Pathology, Aichi Medical University Hospital, Aichi, Japan
| | - Tomohiko Ichikawa
- Department of Urology, Chiba University Graduate School of Medicine, Chiba, Japan
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Taylor KL, Luta G, Zotou V, Lobo T, Hoffman RM, Davis KM, Potosky AL, Li T, Aaronson D, Van Den Eeden SK. Psychological predictors of delayed active treatment following active surveillance for low‐risk prostate cancer: The Patient REported outcomes for Prostate cARE prospective cohort study. BJUI COMPASS 2021; 3:226-237. [PMID: 35492225 PMCID: PMC9045562 DOI: 10.1002/bco2.124] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Revised: 10/04/2021] [Accepted: 10/20/2021] [Indexed: 11/22/2022] Open
Abstract
Objectives In a prospective, comparative effectiveness study, we assessed clinical and psychological factors associated with switching from active surveillance (AS) to active treatment (AT) among low‐risk prostate cancer (PCa) patients. Methods Using ultra‐rapid case identification, we conducted pretreatment telephone interviews (N = 1139) with low‐risk patients (PSA ≤ 10, Gleason≤6) and follow‐up interviews 6–10 months post‐diagnosis (N = 1057). Among men remaining on AS for at least 12 months (N = 601), we compared those who continued on AS (N = 515) versus men who underwent delayed AT (N = 86) between 13 and 24 months, using Cox proportional hazards models. Results Delayed AT was predicted by time dependent PSA levels (≥10 vs. <10; HR = 5.6, 95% CI 2.4–13.1) and Gleason scores (≥7 vs. ≤6; adjusted HR = 20.2, 95% CI 12.2–33.4). Further, delayed AT was more likely among men whose urologist initially recommended AT (HR = 2.13, 95% CI 1.07–4.22), for whom tumour removal was very important (HR = 2.18, 95% CI 1.35–3.52), and who reported greater worry about not detecting disease progression early (HR = 1.67, 1.05–2.65). In exploratory analyses, 31% (27/86) switched to AT without evidence of progression, while 4.7% (24/515) remained on AS with evidence of progression. Conclusions After adjusting for clinical evidence of disease progression over the first year post‐diagnosis, we found that urologists' initial treatment recommendation and patients' early treatment preferences and concerns about AS each independently predicted undergoing delayed AT during the second year post‐diagnosis. These findings, along with almost one‐half undergoing delayed AT without evidence of progression, suggest the need for greater decision support to remain on AS when it is clinically indicated.
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Affiliation(s)
- Kathryn L. Taylor
- Cancer Prevention and Control Program, Lombardi Comprehensive Cancer Center Georgetown University Washington District of Columbia USA
| | - George Luta
- Department of Biostatistics, Bioinformatics, and Biomathematics, Lombardi Comprehensive Cancer Center Georgetown University Washington District of Columbia USA
| | - Vasiliki Zotou
- Cancer Prevention and Control Program, Lombardi Comprehensive Cancer Center Georgetown University Washington District of Columbia USA
| | - Tania Lobo
- Cancer Prevention and Control Program, Lombardi Comprehensive Cancer Center Georgetown University Washington District of Columbia USA
| | - Richard M. Hoffman
- Division of General Internal Medicine University of Iowa Carver College of Medicine/Iowa City VA Medical Center Iowa City Iowa USA
| | - Kimberly M. Davis
- Cancer Prevention and Control Program, Lombardi Comprehensive Cancer Center Georgetown University Washington District of Columbia USA
| | - Arnold L. Potosky
- Cancer Prevention and Control Program, Lombardi Comprehensive Cancer Center Georgetown University Washington District of Columbia USA
| | - Tengfei Li
- Department of Biostatistics, Bioinformatics, and Biomathematics, Lombardi Comprehensive Cancer Center Georgetown University Washington District of Columbia USA
| | - David Aaronson
- Department of Urology Kaiser Permanente East Bay Oakland California USA
| | - Stephen K. Van Den Eeden
- Division of Research Kaiser Permanente Northern California Oakland California USA
- Department of Urology UCSF San Francisco California USA
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Li G, Li Y, Wang J, Gao X, Zhong Q, He L, Li C, Liu M, Liu Y, Ma M, Wang H, Wang X, Zhu H. Guidelines for radiotherapy of prostate cancer (2020 edition). PRECISION RADIATION ONCOLOGY 2021. [DOI: 10.1002/pro6.1129] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Affiliation(s)
- Gaofeng Li
- Department of Radiation Oncology, Beijing Hospital, National Center of Gerontology; Institute of Geriatric Medicine Chinese Academy of Medical Sciences Beijing P. R. China
| | - Yexiong Li
- State Key Laboratory of Molecular Oncology and Department of Radiation Oncology, National Cancer Center/Cancer Hospital Chinese Academy of Medical Sciences (CAMS) and Peking Union Medical College (PUMC) Beijing P. R. China
| | - Junjie Wang
- Department of Radiation Oncology Peking University Third Hospital Beijing P. R. China
| | - Xianshu Gao
- Department of Radiation Oncology Peking University First Hospital Beijing P. R. China
| | - Qiuzi Zhong
- Department of Radiation Oncology, Beijing Hospital, National Center of Gerontology; Institute of Geriatric Medicine Chinese Academy of Medical Sciences Beijing P. R. China
| | - Liru He
- Department of Radiation Oncology, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine Sun Yat‐sen University Cancer Center Guangzhou 510060 P. R. China
| | - Chunmei Li
- Department of Radiation Oncology, Beijing Hospital, National Center of Gerontology; Institute of Geriatric Medicine Chinese Academy of Medical Sciences Beijing P. R. China
| | - Ming Liu
- Department of Urology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine Chinese Academy of Medical Sciences Beijing P. R. China
| | - Yueping Liu
- State Key Laboratory of Molecular Oncology and Department of Radiation Oncology, National Cancer Center/Cancer Hospital Chinese Academy of Medical Sciences (CAMS) and Peking Union Medical College (PUMC) Beijing P. R. China
| | - Mingwei Ma
- Department of Radiation Oncology Peking University First Hospital Beijing P. R. China
| | - Hao Wang
- Department of Radiation Oncology Peking University Third Hospital Beijing P. R. China
| | - Xuan Wang
- Department of Urology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine Chinese Academy of Medical Sciences Beijing P. R. China
| | - Hui Zhu
- Department of Nuclear Medicine Department, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine Chinese Academy of Medical Sciences Beijing P. R. China
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Çelik S, Kızılay F, Yörükoğlu K, Aslan G, Ozen H, Akdogan B, Sozen S, Baltaci S, Muezzinoglu T, Izol V, Bayazıt Y, Narter F, Türkeri L. Sextant Biopsy-Based Criteria for Clinically Insignificant Prostate Cancer Are Also Valid for the 12-Core Prostate Biopsy Scheme: A Multicenter Study of Urooncology Association, Turkey. Urol Int 2021; 106:35-43. [PMID: 33951662 DOI: 10.1159/000513658] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2020] [Accepted: 12/07/2020] [Indexed: 11/19/2022]
Abstract
BACKGROUND Epstein criteria based on sextant biopsy are assumed to be valid for 12-core biopsies. However, very scarce information is present in the current literature to support this view. OBJECTIVES To investigate the validity of Epstein criteria for clinically insignificant prostate cancer (PCa) in a cohort of the currently utilized 12-core prostate biopsy (TRUS-Bx) scheme in patients with low-risk and intermediate-risk PCa. METHOD Pathological findings were separately evaluated in the areas matching the sextant biopsy (6-core paramedian) scheme and in all 12-core schemes. Patients were divided into 2 groups according to the final pathology report of RP as true clinically significant PCa (sPCa) and insignificant PCa (insPCa) groups. Predictive factors (including Epstein criteria) and cutoff values for the presence of insPCa were separately evaluated for 6- and 12-core TRUS-Bx schemes. Then, different predictive models based on Epstein criteria with or without additional biopsy findings were created. RESULTS A total of 442 patients were evaluated. PSA density, biopsy GS, percentage of tumor and number of positive cores, PNI, and HG-PIN were independent predictive factors for insPCa in both TRUS-Bx schemes. For the 12-core scheme, the best cutoff values of tumor percentage and number of positive cores were found to be ≤50% (OR: 3.662) and 1.5 cores (OR: 2.194), respectively. The best predictive model was found to be that which added 3 additional factors (PNI and HG-PIN absence and number of positive cores) to Epstein criteria (OR: 6.041). CONCLUSIONS Using a cutoff value of "1" for the number of positive biopsy cores and absence of biopsy PNI and HG-PIN findings can be more useful for improving the prediction model of the Epstein criteria in the 12-core biopsy scheme.
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Affiliation(s)
- Serdar Çelik
- Department of Basic Oncology, Izmir Bozyaka Training and Research Hospital, Institute of Oncology, Health Science University, Urology Clinic and Dokuz Eylul University, Izmir, Turkey
| | - Fuat Kızılay
- Department of Urology, Faculty of Medicine, Ege University, Izmir, Turkey
| | - Kutsal Yörükoğlu
- Department of Pathology, Faculty of Medicine, Dokuz Eylul University, Izmir, Turkey
| | - Güven Aslan
- Department of Urology, Faculty of Medicine, Dokuz Eylul University, Izmir, Turkey
| | - Haluk Ozen
- Department of Urology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Bulent Akdogan
- Department of Urology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Sinan Sozen
- Department of Urology, Faculty of Medicine, Gazi University, Ankara, Turkey
| | - Sumer Baltaci
- Department of Urology, Faculty of Medicine, Ankara University, Ankara, Turkey
| | - Talha Muezzinoglu
- Department of Urology, Faculty of Medicine, Celal Bayar University, Manisa, Turkey
| | - Volkan Izol
- Department of Urology, Faculty of Medicine, Cukurova University, Adana, Turkey
| | - Yıldırım Bayazıt
- Department of Urology, Faculty of Medicine, Cukurova University, Adana, Turkey
| | - Fehmi Narter
- Department of Urology, Kadikoy Hospital, Mehmet Ali Aydınlar University, Istanbul, Turkey
| | - Levent Türkeri
- Department of Urology, Altunizade Hospital, Mehmet Ali Aydınlar Acıbadem University, Istanbul, Turkey
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Covas Moschovas M, Chew C, Bhat S, Sandri M, Rogers T, Dell'Oglio P, Roof S, Reddy S, Sighinolfi MC, Rocco B, Patel V. Association Between Oncotype DX Genomic Prostate Score and Adverse Tumor Pathology After Radical Prostatectomy. Eur Urol Focus 2021; 8:418-424. [PMID: 33757735 DOI: 10.1016/j.euf.2021.03.015] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Revised: 02/04/2021] [Accepted: 03/09/2021] [Indexed: 12/26/2022]
Abstract
BACKGROUND The Oncotype DX assay is a clinically validated 17-gene genomic assay that provides a genomic prostate score (GPS; scale 0-100) measuring the heterogeneous nature of prostate tumors. The test is performed on prostate tissue collected during biopsy. There is a lack of data on the association between the GPS and tumor pathology after radical prostatectomy (RP). OBJECTIVE To investigate the association between GPS and final pathology, including extraprostatic extension (EPE), positive surgical margin (PSM), and seminal vesicle invasion (SVI). DESIGN, SETTING, AND PARTICIPANTS Data for the 749 patients who underwent Oncotype DX assay and RP at a referral prostate cancer center between 2015 and 2019 were retrospectively assessed to evaluate the association between GPS and unfavorable pathology parameters. INTERVENTION After a GPS genetic test, patients underwent robotic RP performed by the same surgeon. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS Multivariable logistic regression analyses were performed to assess the association between GPS and EPE, PSM, and SVI. The models were adjusted for age, clinical stage, prostate-specific antigen (PSA) level, Gleason score, and time between the genomic assay and surgery. The median time between Oncotype DX assay and surgery was 176 d (interquartile range [IQR] 141-226). The median age was 63 yr (IQR 58-68), median GPS was 29 (IQR 21-39), and median PSA was 5.7 ng/ml (IQR 4.6-7.7). In multivariable analyses assessing the odds ratio (OR) per 20-point change in GPS, GPS was an independent predictor of EPE (OR 1.8, 95% confidence interval [CI] 1.4-2.3) and SVI (OR 2.1, 95% CI 1.3-3.4). In addition, when patients were grouped by GPS quartile, the percentage of cases with EPE and SVI increased with the GPS quartile. CONCLUSIONS We provide evidence that the Oncotype DX GPS is significantly associated with adverse pathology after RP. Specifically, the risk of EPE and SVI increases with the GPS. Therefore, use of the Oncotype DX GPS may help clinicians to improve preoperative patient counseling and develop surgical strategies for patients with a higher chance of EPE or unfavorable pathological features. PATIENT SUMMARY We studied whether the score for a prostate genetic test was associated with prostate cancer pathology findings for patients who had their prostate removed. We found that the risk of prostate cancer spread outside the gland and to the seminal vesicle increases with higher test scores. These findings may help surgeons in counseling patients on surgical options for prostate cancer.
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Affiliation(s)
| | - Christopher Chew
- University of North Carolina School of Medicine, Chapel Hill, NC, USA
| | - Seetharam Bhat
- AdventHealth Global Robotics Institute, Celebration, FL, USA
| | - Marco Sandri
- Big and Open Data Innovation Laboratory, University of Brescia, Brescia, Italy
| | - Travis Rogers
- AdventHealth Global Robotics Institute, Celebration, FL, USA
| | - Paolo Dell'Oglio
- Department of Urology, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Shannon Roof
- AdventHealth Global Robotics Institute, Celebration, FL, USA
| | - Sunil Reddy
- AdventHealth Global Robotics Institute, Celebration, FL, USA
| | | | | | - Vipul Patel
- AdventHealth Global Robotics Institute, Celebration, FL, USA
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Update on Multiparametric Prostate MRI During Active Surveillance: Current and Future Trends and Role of the PRECISE Recommendations. AJR Am J Roentgenol 2021; 216:943-951. [PMID: 32755219 DOI: 10.2214/ajr.20.23985] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Active surveillance for low-to-intermediate risk prostate cancer is a conservative management approach that aims to avoid or delay active treatment until there is evidence of disease progression. In recent years, multiparametric MRI (mpMRI) has been increasingly used in active surveillance and has shown great promise in patient selection and monitoring. This has been corroborated by publication of the Prostate Cancer Radiologic Estimation of Change in Sequential Evaluation (PRECISE) recommendations, which define the ideal reporting standards for mpMRI during active surveillance. The PRECISE recommendations include a system that assigns a score from 1 to 5 (the PRECISE score) for the assessment of radiologic change on serial mpMRI scans. PRECISE scores are defined as follows: a score of 3 indicates radiologic stability, a score of 1 or 2 denotes radiologic regression, and a score of 4 or 5 indicates radiologic progression. In the present study, we discuss current and future trends in the use of mpMRI during active surveillance and illustrate the natural history of prostate cancer on serial scans according to the PRECISE recommendations. We highlight how the ability to classify radiologic change on mpMRI with use of the PRECISE recommendations helps clinical decision making.
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Clinical experience with active surveillance protocol using regular magnetic resonance imaging instead of regular repeat biopsy for monitoring: A study at a high-volume center in Korea. Prostate Int 2020; 9:90-95. [PMID: 34386451 PMCID: PMC8322812 DOI: 10.1016/j.prnil.2020.11.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Revised: 11/03/2020] [Accepted: 11/09/2020] [Indexed: 11/26/2022] Open
Abstract
Background Here, we report the experience of a multiparameter magnetic resonance imaging (MRI)–based active surveillance (AS) protocol that did not include performing a repeat biopsy after the diagnosis of prostate cancer by prostate biopsy or transurethral resection of prostate. Methods From January 2010 to December 2017, we reviewed 193 patients with newly diagnosed prostate cancer who were eligible for AS. The patients were divided into AS group (n = 122) and definitive treatment group (n = 71) based on initial treatment. Disease progression was defined as a remarkable change in MRI findings. To confirm the stability of protocol, we compared the clinicopathological characteristics of patients who initially underwent radical prostatectomy (RP) (n = 58) and RP after termination of AS (n = 20). Results Among patients who initially selected AS (median adherence duration = 31.4 months), 70 (57.3%) subsequently changed their treatment options. Disease progression (n = 30) was the main cause for termination. No significant differences were found in the clinicopathologic characteristics at initial diagnosis and pathologic outcomes between patients who initially underwent RP and those who chose RP after termination of AS. In a comparative analysis of diagnostic methods, the patients with incidental prostate cancer by transurethral resection of prostate had higher age, lower prostate-specific antigen level and density, as well as longer AS adherence duration and follow-up duration compared with those diagnosed by prostate biopsy. Conclusions Our AS monitoring protocol, which depends on MRI instead of regular repeat biopsy, was feasible. Patients with incidental prostate cancer continued AS more compared with patients diagnosed by prostate biopsy.
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Song SH, Kim JK, Lee H, Lee S, Hong SK, Byun SS. A single-center long-term experience of active surveillance for prostate cancer: 15 years of follow-up. Investig Clin Urol 2020; 62:32-38. [PMID: 33258324 PMCID: PMC7801164 DOI: 10.4111/icu.20200206] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Revised: 06/29/2020] [Accepted: 07/17/2020] [Indexed: 12/01/2022] Open
Abstract
Purpose To describe a single-center 15-year experience of active surveillance (AS) for prostate cancer (PCa). Materials and Methods We retrospectively reviewed patients who underwent AS between 2003 and 2018. One hundred fifty-three patients were selected according to the following criteria: (1) biopsy Gleason pattern ≤3+4 with (2) ≤two positive core(s) and (3) ≤50% core involvement, clinical-stage ≤T2a, and prostate-specific antigen (PSA) ≤20 ng/mL. Follow-up included PSA measurement every six months, prostate biopsies at one year and then every 2–3 years, and MRI every year. Intervention was triggered by (1) Gleason score (GS) upgrading, (2) >two positive cores, or (3) PSA doubling-time in <3 years. Results Mean (±standard deviation) follow-up was 36.4 (±31.9) months. Ninety-three (60.8%) and 20 (13.1%) patients received second and third biopsies, respectively. Seventy-two patients (47.1%) discontinued AS for various reasons (59, intervention; 13, follow-up loss). Reasons for intervention consisted of GS upgrading (42.4%), >two positive cores (8.5%), abnormal PSA kinetics (11.9%), and patient preference (37.3%). Notably, 12 (25.5%) patients had pathologic GS ≥4+3 (unfavorable disease) and 3 (6.4%) patients had pathologic stage ≥T3a at radical prostatectomy. Median time to treatment-free survival was 19.5 months. Of the 59 patients who switched to intervention, biochemical recurrence was reported in only one (0.7%) patient. Conclusions AS is an available option for low-risk PCa in carefully selected patients. Further larger prospective studies are needed to determine the optimal criteria for AS, especially in Korean PCa patients.
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Affiliation(s)
- Sang Hun Song
- Department of Urology, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Jung Kwon Kim
- Department of Urology, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Hakmin Lee
- Department of Urology, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Sangchul Lee
- Department of Urology, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Sung Kyu Hong
- Department of Urology, Seoul National University Bundang Hospital, Seongnam, Korea.,Department of Urology, Seoul National University College of Medicine, Seoul, Korea
| | - Seok Soo Byun
- Department of Urology, Seoul National University Bundang Hospital, Seongnam, Korea.,Department of Urology, Seoul National University College of Medicine, Seoul, Korea.
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Deka R, Courtney PT, Parsons JK, Nelson TJ, Nalawade V, Luterstein E, Cherry DR, Simpson DR, Mundt AJ, Murphy JD, D’Amico AV, Kane CJ, Martinez ME, Rose BS. Association Between African American Race and Clinical Outcomes in Men Treated for Low-Risk Prostate Cancer With Active Surveillance. JAMA 2020; 324:1747-1754. [PMID: 33141207 PMCID: PMC7610194 DOI: 10.1001/jama.2020.17020] [Citation(s) in RCA: 41] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE There is concern that African American men with low-risk prostate cancer may harbor more aggressive disease than non-Hispanic White men. Therefore, it is unclear whether active surveillance is a safe option for African American men. OBJECTIVE To compare clinical outcomes of African American and non-Hispanic White men with low-risk prostate cancer managed with active surveillance. DESIGN, SETTING, AND PARTICIPANTS Retrospective cohort study in the US Veterans Health Administration Health Care System of African American and non-Hispanic White men diagnosed with low-risk prostate cancer between January 1, 2001, and December 31, 2015, and managed with active surveillance. The date of final follow-up was March 31, 2020. EXPOSURES Active surveillance was defined as no definitive treatment within the first year of diagnosis and at least 1 additional surveillance biopsy. MAIN OUTCOMES AND MEASURES Progression to at least intermediate-risk, definitive treatment, metastasis, prostate cancer-specific mortality, and all-cause mortality. RESULTS The cohort included 8726 men, including 2280 African American men (26.1%) (median age, 63.2 years) and 6446 non-Hispanic White men (73.9%) (median age, 65.5 years), and the median follow-up was 7.6 years (interquartile range, 5.7-9.9; range, 0.2-19.2). Among African American men and non-Hispanic White men, respectively, the 10-year cumulative incidence of disease progression was 59.9% vs 48.3% (difference, 11.6% [95% CI, 9.2% to 13.9%); P < .001); of receipt of definitive treatment, 54.8% vs 41.4% (difference, 13.4% [95% CI, 11.0% to 15.7%]; P < .001); of metastasis, 1.5% vs 1.4% (difference, 0.1% [95% CI, -0.4% to 0.6%]; P = .49); of prostate cancer-specific mortality, 1.1% vs 1.0% (difference, 0.1% [95% CI, -0.4% to 0.6%]; P = .82); and of all-cause mortality, 22.4% vs 23.5% (difference, 1.1% [95% CI, -0.9% to 3.1%]; P = 0.09). CONCLUSIONS AND RELEVANCE In this retrospective cohort study of men with low-risk prostate cancer followed up for a median of 7.6 years, African American men, compared with non-Hispanic White men, had a statistically significant increased 10-year cumulative incidence of disease progression and definitive treatment, but not metastasis or prostate cancer-specific mortality. Longer-term follow-up is needed to better assess the mortality risk.
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Affiliation(s)
- Rishi Deka
- VHA San Diego Health Care System, La Jolla, California
- Department of Radiation Medicine and Applied Sciences, University of California San Diego School of Medicine, La Jolla
| | - P. Travis Courtney
- VHA San Diego Health Care System, La Jolla, California
- Department of Radiation Medicine and Applied Sciences, University of California San Diego School of Medicine, La Jolla
| | - J. Kellogg Parsons
- VHA San Diego Health Care System, La Jolla, California
- Department of Urology, University of California San Diego School of Medicine, La Jolla
| | - Tyler J. Nelson
- VHA San Diego Health Care System, La Jolla, California
- Department of Radiation Medicine and Applied Sciences, University of California San Diego School of Medicine, La Jolla
| | - Vinit Nalawade
- VHA San Diego Health Care System, La Jolla, California
- Department of Radiation Medicine and Applied Sciences, University of California San Diego School of Medicine, La Jolla
| | - Elaine Luterstein
- VHA San Diego Health Care System, La Jolla, California
- Department of Radiation Medicine and Applied Sciences, University of California San Diego School of Medicine, La Jolla
| | - Daniel R. Cherry
- VHA San Diego Health Care System, La Jolla, California
- Department of Radiation Medicine and Applied Sciences, University of California San Diego School of Medicine, La Jolla
| | - Daniel R. Simpson
- VHA San Diego Health Care System, La Jolla, California
- Department of Radiation Medicine and Applied Sciences, University of California San Diego School of Medicine, La Jolla
| | - Arno J. Mundt
- Department of Radiation Medicine and Applied Sciences, University of California San Diego School of Medicine, La Jolla
| | - James D. Murphy
- VHA San Diego Health Care System, La Jolla, California
- Department of Radiation Medicine and Applied Sciences, University of California San Diego School of Medicine, La Jolla
| | - Anthony V. D’Amico
- Department of Radiation Oncology, Harvard Medical School, Cambridge, Massachusetts
- Dana-Farber Cancer Institute, Harvard Medical School, Cambridge, Massachusetts
- Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
| | - Christopher J. Kane
- Department of Urology, University of California San Diego School of Medicine, La Jolla
| | - Maria Elena Martinez
- Department of Family Medicine and Public Health, University of California San Diego School of Medicine, La Jolla
| | - Brent S. Rose
- VHA San Diego Health Care System, La Jolla, California
- Department of Radiation Medicine and Applied Sciences, University of California San Diego School of Medicine, La Jolla
- Department of Urology, University of California San Diego School of Medicine, La Jolla
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O'Connor LP, Wang AZ, Yerram NK, Lebastchi AH, Ahdoot M, Gurram S, Zeng J, Mehralivand S, Harmon S, Merino MJ, Parnes HL, Choyke PL, Turkbey B, Wood BJ, Pinto PA. Combined MRI-targeted Plus Systematic Confirmatory Biopsy Improves Risk Stratification for Patients Enrolling on Active Surveillance for Prostate Cancer. Urology 2020; 144:164-170. [PMID: 32679272 PMCID: PMC8916164 DOI: 10.1016/j.urology.2020.06.061] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Revised: 05/29/2020] [Accepted: 06/28/2020] [Indexed: 01/13/2023]
Abstract
OBJECTIVE To evaluate the efficacy of combined MRI-targeted plus systematic 12-core biopsy (Cbx) to aid in the selection of patients for active surveillance (AS). METHODS From July 2007 to January 2020, patients with Gleason Grade Group (GG) 1 or GG 2 prostate cancer were referred to our center for AS consideration. All patients underwent an MRI and confirmatory combined MRI-targeted plus systematic biopsy (Cbx), and AS outcomes based on Cbx results were compared. Cox regression was used to identify predictors of AS failure, defined as progression to ≥ GG3 disease on follow-up biopsies. RESULTS Of 579 patients referred for AS, 79.3% (459/579) and 20.7% (120/579) had an initial diagnosis of GG1 and GG2 disease, respectively. Overall, 43.2% of patients (250/579) were upgraded on confirmatory Cbx, with 19.2% (111/579) upgraded to ≥ GG3. For the 226 patients followed on AS, 32.7% (74/226) had benign, 45.6% (103/226) had GG1, and 21.7% (49/226) had GG2 results on confirmatory Cbx. In total, 28.8% (65/226) of patients eventually progressed to ≥ GG3, with a median time to AS failure of 89 months. The median time from confirmatory Cbx to AS failure for the negative, GG1, and GG2 groups were 97, 97, and 32 months, respectively (p < .001). On multivariable regression, only age (hazard ratio 1.06 [1.02-1.11], p < .005) and GG on confirmatory Cbx (hazard ratio 2.75 [1.78-4.26], p < .005) remained as positive predictors of AS failure. CONCLUSION The confirmatory combined MRI-targeted plus systematic biopsy provides useful information for the risk stratification of patients at the time of AS enrollment.
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Affiliation(s)
- Luke P O'Connor
- Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - Alex Z Wang
- Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - Nitin K Yerram
- Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - Amir H Lebastchi
- Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - Michael Ahdoot
- Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - Sandeep Gurram
- Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - Johnathan Zeng
- Center for Interventional Oncology, National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - Sherif Mehralivand
- Molecular Imaging Program, National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - Stephanie Harmon
- Clinical Research Directorate, Frederick National Laboratory for Cancer Research sponsored by the National Cancer Institute, Frederick, MD
| | - Maria J Merino
- Laboratory of Pathology, National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - Howard L Parnes
- Division of Cancer Prevention, National Cancer Institutes, National Institutes of Health, Bethesda, MD
| | - Peter L Choyke
- Molecular Imaging Program, National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - Baris Turkbey
- Molecular Imaging Program, National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - Bradford J Wood
- Center for Interventional Oncology, National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - Peter A Pinto
- Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD
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11
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Murray NP, Fuentealba C, Reyes E, Salazar A, Guzman E, Orrego S. The Epstein criteria predict for organ-confined prostate cancer but not for minimal residual disease and outcome after radical prostatectomy. Turk J Urol 2020; 46:360-366. [PMID: 32707032 DOI: 10.5152/tud.2020.20147] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2020] [Accepted: 05/30/2020] [Indexed: 11/22/2022]
Abstract
OBJECTIVE The Epstein criteria (EC) used to select men for active surveillance do not predict biologically insignificant diseases. Minimal residual disease (MRD) is an undetected microscopic disease that remains after radical prostectomy (RP) and is a biological classification associated with the risk of treatment failure. Subtypes of MRD, the 10-year biochemical failure free survival (BFFS), and restricted mean biochemical failure free survival time (RMST) were determined and compared in EC patients treated with RP. MATERIAL AND METHODS Consecutive patients with a Gleason 6 biopsy treated at a single institution were divided into those who did or did not fulfill the EC and underwent RP. One month after surgery, samples were taken for the detection of circulating prostate cells (CPCs) and bone marrow micrometastasis. MRD was defined as negative for both CPCs and micrometastasis; patients were positive for micrometastasis and CPCs separately. BFFS for up to 10 years and RMST were determined for each MRD subgroup for EC positive and negative patients. RESULTS EC positive men (137/426) were significantly older (p<0.05) and had negative MRD, pT2 (pathologically organ confined) disease (<0.02), and lower frequency of upgrading (p<0.02). Of the EC positive men, 71% were MRD negative, 13% were positive for micrometastasis, and 16% were positive for CPCs with respective 10-year BFFS of 99%, 89%, and 21% (<0.001) (hazard ratio: 1.00, 1.76, 4.03, respectively) with no signficant differences between the 10-year BFFS or RMST for MRD subgroups for EC positive and negative patients. CONCLUSIONS EC predict pT2, MRD negative disease; however, 29% are MRD positive with a high risk of treatment failure.
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Affiliation(s)
- Nigel P Murray
- Faculty of Medicine, University Finis Terrae, Providencia, Santiago, Chile.,Department of Medicine, Hospital de Carabineros de Chile, Ñuñoa, Santiago, Chile
| | - Cynthia Fuentealba
- Department of Urology, Hospital de Carabineros de Chile, Ñuñoa, Santiago, Chile
| | - Eduardo Reyes
- Faculty of Medicine, University Diego Portales, Santiago, Chile.,Urology Service, Hospital DIPRECA, Las Condes, Santiago, Chile
| | - Anibal Salazar
- Department of Urology, Hospital de Carabineros de Chile, Ñuñoa, Santiago, Chile
| | - Eghon Guzman
- Department of Medicine, Hospital de Carabineros de Chile, Ñuñoa, Santiago, Chile
| | - Shenda Orrego
- Department of Medicine, Hospital de Carabineros de Chile, Ñuñoa, Santiago, Chile
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12
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Bates AS, Kostakopoulos N, Ayers J, Jameson M, Todd J, Lukha R, Cymes W, Chasapi D, Brown N, Bhattacharya Y, Paterson C, Lam TBL. A Narrative Overview of Active Surveillance for Clinically Localised Prostate Cancer. Semin Oncol Nurs 2020; 36:151045. [PMID: 32703714 DOI: 10.1016/j.soncn.2020.151045] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND -Active surveillance (AS) is a strategy employed as an alternative to immediate standard active treatments for patients with low-risk localised prostate cancer (PCa). Active treatments such as radical prostatectomy and radiotherapy are associated with significant adverse effects which impair quality of life. The majority of patients with low-risk PCa undergo a slow and predictable course of cancer growth and do not require immediate curative treatment. AS provides a means to identify and monitor patients with low-risk PCa through regular PSA testing, imaging using MRI scans and regular repeat prostate biopsies. These measures enable the identification of progression, or increase in cancer extent or aggressiveness, which necessitates curative treatment. Alternatively, some patients may choose to leave AS to pursue curative interventions due to anxiety. The main benefit of AS is the avoidance of unnecessary radical treatments for patients at the early stages of the disease, hence avoiding over-treatment, whilst identifying those at risk of progression to be treated actively. The objective of this article is to provide a narrative summary of contemporary practice regarding AS based on a review of the available evidence base and clinical practice guidelines. Elements of discussion include the clinical effectiveness and harms of AS, what AS involves for healthcare professionals, and patient perspectives. The pitfalls and challenges for healthcare professionals are also discussed. DATA SOURCES We consulted international guidelines, collaborative studies and seminal prospective studies on AS in the management of clinically localised PCa. CONCLUSION AS is a feasible alternative to radical treatment options for low-risk PCa, primarily as a means of avoiding over-treatment, whilst identifying those who are at risk of disease progression for active treatment. There is emerging data demonstrating the long-term safety of AS as an oncological management strategy. Uncertainties remain regarding variation in definitions, criteria, thresholds and the most effective types of diagnostic interventions pertaining to patient selection, monitoring and reclassification. Efforts have been made to standardise the practice and conduct of AS. As data from high-quality prospective comparative studies mature, the practice of AS will continue to evolve. IMPLICATIONS FOR NURSING PRACTICE The practice of AS involves a multi-disciplinary team of healthcare professionals consisting of nurses, urologists, oncologists, pathologists and radiologists. Nurses play a prominent role in managing AS programmes, and are closely involved in patient selection and recruitment, counselling, organising and administering diagnostic interventions including prostate biopsies, and ensuring patients' needs are being met throughout the duration of AS.
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Affiliation(s)
- Anthony S Bates
- Department of Urology, Aberdeen Royal Infirmary, Foresterhill, Aberdeen, Scotland, United Kingdom
| | - Nikolaos Kostakopoulos
- Department of Urology, Aberdeen Royal Infirmary, Foresterhill, Aberdeen, Scotland, United Kingdom
| | - Jennifer Ayers
- Department of Urology, Aberdeen Royal Infirmary, Foresterhill, Aberdeen, Scotland, United Kingdom
| | - Molly Jameson
- Warrington and Halton Teaching Hospitals NHS Foundation Trust, England, United Kingdom
| | - James Todd
- Worcester Acute Hospitals NHS Trust, England, United Kingdom
| | - Ravi Lukha
- Oxford University Hospitals NHS Foundation Trust, England, United Kingdom
| | - Wojciech Cymes
- Department of Urology, Aberdeen Royal Infirmary, Foresterhill, Aberdeen, Scotland, United Kingdom
| | - Despoina Chasapi
- University of Aberdeen School of Medicine, Foresterhill, Aberdeen, Scotland, United Kingdom
| | - Nicole Brown
- University of Aberdeen School of Medicine, Foresterhill, Aberdeen, Scotland, United Kingdom
| | - Yagnaseni Bhattacharya
- University of Aberdeen School of Medicine, Foresterhill, Aberdeen, Scotland, United Kingdom
| | - Catherine Paterson
- University of Canberra, School of Nursing, Midwifery and Public Health, Canberra, Australia
| | - Thomas B L Lam
- Department of Urology, Aberdeen Royal Infirmary, Foresterhill, Aberdeen, Scotland, United Kingdom; Academic Urology Unit, University of Aberdeen, Foresterhill, Aberdeen, Scotland, United Kingdom.
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Deka R, Parsons JK, Simpson DR, Riviere P, Nalawade V, Vitzthum LK, Kader AK, Kane CJ, Rock CS, Murphy JD, Rose BS. African-American men with low-risk prostate cancer treated with radical prostatectomy in an equal-access health care system: implications for active surveillance. Prostate Cancer Prostatic Dis 2020; 23:581-588. [DOI: 10.1038/s41391-020-0230-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2020] [Revised: 03/24/2020] [Accepted: 03/31/2020] [Indexed: 12/31/2022]
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Survey on the practice of active surveillance for prostate cancer from the Middle East. Prostate Int 2020; 8:41-48. [PMID: 32257977 PMCID: PMC7125368 DOI: 10.1016/j.prnil.2019.11.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2019] [Revised: 11/10/2019] [Accepted: 11/14/2019] [Indexed: 11/29/2022] Open
Abstract
Background Prostate cancer is the most common cancer among Lebanese men. Management of prostate cancer includes medical, radiological, and surgical intervention. In addition, active surveillance (AS) is proven as a valid option in patients with low-risk prostate cancer. Currently, data from the Middle East about AS are scarce. The aim of this study is to assess the rate of implementation of AS by physicians, determine the selection and follow-up criteria used by physicians, and identify potential barriers to its widespread adoption. Methods After receiving ethical approval, a LimeSurvey electronic questionnaire was mailed to 206 eligible urologists, oncologists, and radiation oncologists registered in the order of physicians in Lebanon. The questionnaire included dichotomous, multiple choice questions, and multiple answer questions. The 23 questions tackled sociodemographic information, physician's attitude toward AS, and their current practices. Predictors of AS use were identified using the chi-squared and Fisher's exact test. Then, multivariate logistic regression model for the predictors of AS practice was conducted. Results The response rate was 25%, and the analysis was run on 52 respondents. Although most of the respondents agreed that AS is a valid modality for low-risk prostate cancer, only 34 (65.4%) of them had patients on active surveillance. The rate of patients on AS was also very low. Urologists, physicians with >15 years of experience, and those who practiced in a university hospital were all predictors of AS usage (p = 0.005; p = 0.002; p = 0.025, respectively). However, physicians with fear of patient noncompliance had the odds of resorting to this modality [odds ratio (OR) = 0.07 (0.01 – 0.76)]. Conclusion The main obstacles to implementing AS were fear of patient noncompliance and lack of national awareness as well as acceptance among the Lebanese uro-oncological body. Efforts to decentralize knowledge and expertize to new health-care practitioners and community hospitals would encourage its implementation.
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15
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Harat A, Harat M, Martinson M. A Cost-Effectiveness and Quality of Life Analysis of Different Approaches to the Management and Treatment of Localized Prostate Cancer. Front Oncol 2020; 10:103. [PMID: 32117753 PMCID: PMC7026676 DOI: 10.3389/fonc.2020.00103] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2019] [Accepted: 01/20/2020] [Indexed: 01/22/2023] Open
Abstract
The aim of this study was to compare the cost-effectiveness and quality-adjusted life years (QALYs) of active monitoring (AM), radical prostatectomy (PR), and external-beam radiotherapy with neoadjuvant hormone therapy (RT) for localized prostate cancer. Microsimulations of radical prostatectomy, 3D-conformal radiotherapy, or active monitoring were performed using Medicare reimbursement schedules and clinical trial results for a target population of men aged 50–69 years with newly diagnosed localized prostate cancer (T1-T2, NX, M0) over a time horizon of 10 years. Quality-adjusted life years (QALYs) and costs were assessed and sensitivity analyses performed. Monte Carlo simulations revealed that the mean cost for AM, PR, and RT were $15,654, $18,791, and $30,378, respectively, and QALYs were 6.96, 7.44, and 7.9 years, respectively. The incremental cost-effectiveness ratio (ICER) was $6,548 for PR over AM and $68,339 for RT over PR. Results were sensitive to the number of years of follow-up and procedure cost. With relaxed assumptions for AM, the ICER of PR and RT met the societal willingness to pay (WTP) threshold of $50,000 per QALY. Compared with AM, PR was highly cost-effective. RT and PR for localized prostate cancer can be cost-effective, but RT must offer increased QALYs or decreased procedural costs to be cost-effective compared to PR. Newer and cheaper radiotherapy strategies like stereotactic body radiotherapy may play a crucial role in future early prostate cancer management.
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Affiliation(s)
- Aleksandra Harat
- Department of Social and Medical Sciences, Ludwik Rydygier Collegium Medicum, Nicolaus Copernicus University, Bydgoszcz, Poland
| | - Maciej Harat
- Department of Oncology and Brachytherapy, Ludwik Rydygier Collegium Medicum, Nicolaus Copernicus University, Bydgoszcz, Poland.,Department of Radiotherapy, Franciszek Lukaszczyk Oncology Center, Bydgoszcz, Poland
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16
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van der Wilk BJ, Eyck BM, Spaander MC, Valkema R, Lagarde SM, Wijnhoven BP, van Lanschot JJB. Towards an Organ-Sparing Approach for Locally Advanced Esophageal Cancer. Dig Surg 2019; 36:462-469. [PMID: 30227434 PMCID: PMC6878756 DOI: 10.1159/000493435] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2018] [Accepted: 09/01/2018] [Indexed: 12/13/2022]
Abstract
BACKGROUND Active surveillance after neoadjuvant therapies has emerged among several malignancies. During active surveillance, frequent assessments are performed to detect residual disease and surgery is only reserved for those patients in whom residual disease is proven or highly suspected without distant metastases. After neoadjuvant chemoradiotherapy (nCRT), nearly one-third of esophageal cancer patients achieve a pathologically complete response (pCR). Both patients that achieve a pCR and patients that harbor subclinical disseminated disease after nCRT could benefit from an active surveillance strategy. SUMMARY Esophagectomy is still the cornerstone of treatment in patients with esophageal cancer. Non-surgical treatment via definitive chemoradiotherapy (dCRT) is currently reserved only for patients not eligible for esophagectomy. Since salvage esophagectomy after dCRT (50-60 Gy) results in increased complications, morbidity and mortality compared to surgery after nCRT (41.4 Gy), the latter seems preferable in the setting of active surveillance. Clinical response evaluations can detect substantial (i.e., tumor regression grade [TRG] 3-4) tumors after nCRT with a sensitivity of 90%, minimizing the risk of development of non-resectable recurrences. Current scarce and retrospective literature suggests that active surveillance following nCRT might not jeopardize overall survival and postponed surgery could be performed safely. Key Message: Before an active surveillance approach could be considered standard treatment, results of phase III randomized trials should be awaited.
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Affiliation(s)
- Berend Jan van der Wilk
- Department of Surgery, Erasmus MC, University Medical Center, Rotterdam, The Netherlands,*Berend Jan van der Wilk, MD, Department of Surgery, Erasmus MC, University Medical Center Rotterdam, Dr. Molewaterplein 40, PO Box 2040, Suite Na-2119, NL–3015 GD Rotterdam (The Netherlands), E-Mail
| | - Ben M. Eyck
- Department of Surgery, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - Manon C.W. Spaander
- Department of Gastroenterology and Hepatology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - Roelf Valkema
- Department of Radiology and Nuclear Medicine, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - Sjoerd M. Lagarde
- Department of Surgery, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - Bas P.L. Wijnhoven
- Department of Surgery, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - J. Jan B. van Lanschot
- Department of Surgery, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
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Defining and Measuring Adherence in Observational Studies Assessing Outcomes of Real-world Active Surveillance for Prostate Cancer: A Systematic Review. Eur Urol Oncol 2019; 4:192-201. [PMID: 31288992 DOI: 10.1016/j.euo.2019.06.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2019] [Revised: 05/31/2019] [Accepted: 06/12/2019] [Indexed: 01/21/2023]
Abstract
CONTEXT Evidence-based guidelines for active surveillance (AS), a treatment option for men with low-risk prostate cancer, recommend regular follow-up at periodic intervals to monitor disease progression. However, gaps in monitoring can lead to delayed detection of cancer progression, leading to a missed window of curability. OBJECTIVE We aimed to identify the extent to which real-world observational studies reported adherence to monitoring protocols among prostate cancer patients on AS. When reported, we sought to characterize definitions of adherence. EVIDENCE ACQUISITION We systematically reviewed observational studies assessing outcomes of prostate cancer patients on AS, published before March 22, 2019 in PubMed, Embase, and CENTRAL. Adherence definitions were considered time bound if they included prespecified time and binary if adherence was assessed but did not specify a time interval. We assessed study quality using the Strengthening the Reporting of Observational Studies in Epidemiology checklist. EVIDENCE SYNTHESIS Forty-five studies met our inclusion criteria. Eleven studies did not report any data on adherence to AS protocols. Twenty-five studies did not explicitly measure adherence, but provided relevant data (eg, number of patients who received a repeat biopsy). Six studies reported adherence using a time-bound definition, while three studies used a binary definition. Twenty-three studies provided information on patients lost to follow-up. CONCLUSIONS Most studies reporting outcomes of patients on AS did not measure or report adherence. When reported, adherence was often not time specific. As some AS patients will benefit from maintaining a window of curability, clinical practices and future studies should track and report adherence and associated factors. PATIENT SUMMARY We reviewed real-world observational studies examining outcomes of prostate cancer patients on active surveillance. Most studies did not clearly define or report adherence to monitoring protocols, which is important to consider for appropriate disease management.
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Colicchia M, Morlacco A, Rangel LJ, Carlson RE, Dal Moro F, Karnes RJ. Role of Metabolic Syndrome on Perioperative and Oncological Outcomes at Radical Prostatectomy in a Low-risk Prostate Cancer Cohort Potentially Eligible for Active Surveillance. Eur Urol Focus 2019; 5:425-432. [DOI: 10.1016/j.euf.2017.12.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2017] [Revised: 12/04/2017] [Accepted: 12/18/2017] [Indexed: 12/31/2022]
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Standardized Magnetic Resonance Imaging Reporting Using the Prostate Cancer Radiological Estimation of Change in Sequential Evaluation Criteria and Magnetic Resonance Imaging/Transrectal Ultrasound Fusion with Transperineal Saturation Biopsy to Select Men on Active Surveillance. Eur Urol Focus 2019; 7:102-110. [PMID: 30878348 DOI: 10.1016/j.euf.2019.03.001] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Revised: 02/04/2019] [Accepted: 03/01/2019] [Indexed: 01/27/2023]
Abstract
BACKGROUND Contemporary selection criteria for men with prostate cancer (PC) suitable for active surveillance (AS) are unsatisfactory, leading to high disqualification rates based on tumor misclassification. Conventional biopsy protocols are based on standard 12-core transrectal ultrasound (TRUS) biopsy. OBJECTIVE To assess the value of magnetic resonance imaging (MRI)/TRUS fusion biopsy over 4-yr follow-up in men on AS for low-risk PC. DESIGN, SETTING, AND PARTICIPANTS Between 2010 and 2018, a total of 273 men were included. Of them, 157 men with initial 12-core TRUS biopsy and 116 with initial MRI/TRUS fusion biopsy were followed by systematic and targeted transperineal MRI/TRUS fusion biopsies based on Prostate Cancer Research International Active Surveillance criteria. MRI from follow-up MRI/TRUS fusion biopsy was assessed using the Prostate Cancer Radiological Estimation of Change in Sequential Evaluation (PRECISE) scoring system. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS AS-disqualification rates for patients on AS initially diagnosed by either 12-core TRUS biopsy or by MRI/TRUS fusion biopsy were compared using Kaplan-Meier estimates, log-rank tests, and regression analyses. We also analyzed the influence of negative primary MRI and PRECISE scoring to predict AS disqualification using Kaplan-Meier estimates, log-rank tests, and receiver operating characteristic (ROC) curve analysis. RESULTS AND LIMITATIONS Of men diagnosed by 12-core TRUS biopsy, 59% were disqualified from AS based on the results of subsequent MRI/TRUS fusion biopsy. In the initial MRI fusion biopsy cohort, upgrading occurred significantly less frequently (19%, p<0.001). ROC curve analyses demonstrated good discrimination for the PRECISE score with an area under the curve of 0.83. No men with a PRECISE score of 1 or 2 (demonstrating absence or downgrading of lesions in follow-up MRI) were disqualified from AS. In our cohort, a negative baseline MRI scan was not a predictor of nondisqualification from AS. Limitations include transperineal approach and extended systematic biopsies used with MRI/TRUS fusion biopsy, which may not be representative of other centers. CONCLUSIONS MRI/TRUS fusion biopsies allow a reliable risk classification for patients who are candidates for AS. The application of the PRECISE scoring system demonstrated good discrimination. PATIENT SUMMARY In this study, we investigated the value of multiparametric magnetic resonance imaging (MRI) and MRI/transrectal ultrasound (TRUS) fusion biopsies for the assessment of active surveillance (AS) reliability using the Prostate Cancer Radiological Estimation of Change in Sequential Evaluation criteria. Standard TRUS biopsies lead to significant underestimation of prostate cancer. In contrast, MRI/TRUS fusion biopsies allowed for a more reliable risk classification. For appropriate inclusion into AS, men should receive either an initial or a confirmatory MRI/TRUS fusion biopsy.
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Bloom JB, Hale GR, Gold SA, Rayn KN, Smith C, Mehralivand S, Czarniecki M, Valera V, Wood BJ, Merino MJ, Choyke PL, Parnes HL, Turkbey B, Pinto PA. Predicting Gleason Group Progression for Men on Prostate Cancer Active Surveillance: Role of a Negative Confirmatory Magnetic Resonance Imaging-Ultrasound Fusion Biopsy. J Urol 2019; 201:84-90. [PMID: 30577395 DOI: 10.1016/j.juro.2018.07.051] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
PURPOSE Active surveillance has gained acceptance as an alternative to definitive therapy in many men with prostate cancer. Confirmatory biopsies to assess the appropriateness of active surveillance are routinely performed and negative biopsies are regarded as a favorable prognostic indicator. We sought to determine the prognostic implications of negative multiparametric magnetic resonance imaging-transrectal ultrasound guided fusion biopsy consisting of extended sextant, systematic biopsy plus multiparametric magnetic resonance imaging guided targeted biopsy of suspicious lesions on magnetic resonance imaging. MATERIALS AND METHODS All patients referred with Gleason Grade Group 1 or 2 prostate cancer based on systematic biopsy performed elsewhere underwent confirmatory fusion biopsy. Patients who continued on active surveillance after a positive or a negative fusion biopsy were followed. The baseline characteristics of the biopsy negative and positive cases were compared. Cox regression analysis was used to determine the prognostic significance of a negative fusion biopsy. Kaplan-Meier survival curves were used to estimate Grade Group progression with time. RESULTS Of the 542 patients referred with Grade Group 1 (466) or Grade Group 2 (76) cancer 111 (20.5%) had a negative fusion biopsy. A total of 60 vs 122 patients with a negative vs a positive fusion biopsy were followed on active surveillance with a median time to Grade Group progression of 74.3 and 44.6 months, respectively (p <0.01). Negative fusion biopsy was associated with a reduced risk of Grade Group progression (HR 0.41, 95% CI 0.22-0.77, p <0.01). CONCLUSIONS A negative confirmatory fusion biopsy confers a favorable prognosis for Grade Group progression. These results can be used when counseling patients about the risk of progression and for planning future followup and biopsies in patients on active surveillance.
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Affiliation(s)
- Jonathan B Bloom
- Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Graham R Hale
- Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Samuel A Gold
- Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Kareem N Rayn
- Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Clayton Smith
- Molecular Imaging Program, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Sherif Mehralivand
- Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland.,Molecular Imaging Program, National Cancer Institute, National Institutes of Health, Bethesda, Maryland.,Department of Urology and Pediatric Urology, University Medical Center Mainz, Mainz, Germany
| | - Marcin Czarniecki
- Molecular Imaging Program, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Vladimir Valera
- Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Bradford J Wood
- Center for Interventional Oncology, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Maria J Merino
- Laboratory of Pathology, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Peter L Choyke
- Molecular Imaging Program, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Howard L Parnes
- Division of Cancer Prevention, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Baris Turkbey
- Molecular Imaging Program, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Peter A Pinto
- Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland.,Center for Interventional Oncology, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
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Islamoglu E, Kisa E, Yucel C, Celik O, Cakmak O, Yalbuzdag O, Kozacıoglu Z. Can we expand the borders in active surveillance for low-risk prostate cancer? JOURNAL OF CLINICAL UROLOGY 2019. [DOI: 10.1177/2051415818776190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Purpose: We assessed the outcomes of men with low-risk prostate cancer enrolled in active surveillance. Methods: From January 2008, patients in our clinic who were classified as having low-risk prostate cancer according to the D’Amico classification were included in the protocol. Follow-up consisted of regular prostate-specific antigen tests, digital rectal examinations and biopsies. Outcomes were compared between men who progressed and those who did not, and survival analysis was obtained. Results: The mean follow-up period was 46 months. A total of six patients received curative treatment during follow-up as a result of meeting progression criteria. The mean follow-up time from the beginning of active surveillance until curative therapy was 27.1 months. Four of our 64 patients lost their lives due to diseases other than prostate cancer, none of the patients were lost due to prostate cancer. When patients who showed progression and those who did not were compared in terms of positive core numbers and the core tumour percentage we found no significant difference between the two groups ( P>0.05) Conclusion: Active surveillance seems to be a safe and feasible practice in men with low-risk prostate cancer. Gleason score, clinical stage and initial prostate-specific antigen seem to be the most definite criteria for the selection of patients, while it is thought that the number of positive cores is a matter that can be dealt with more flexibility. Level of evidence: Not applicable for this multicentre audit.
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Affiliation(s)
- Ekrem Islamoglu
- Department of Urology, Izmir Tepecik Education and Research Hospital, Turkey
| | - Erdem Kisa
- Department of Urology, Izmir Tepecik Education and Research Hospital, Turkey
| | - Cem Yucel
- Department of Urology, Izmir Tepecik Education and Research Hospital, Turkey
| | - Orcun Celik
- Department of Urology, Izmir Tepecik Education and Research Hospital, Turkey
| | - Ozgur Cakmak
- Department of Urology, Izmir Tepecik Education and Research Hospital, Turkey
| | - Okan Yalbuzdag
- Department of Urology, Izmir Tepecik Education and Research Hospital, Turkey
| | - Zafer Kozacıoglu
- Department of Urology, Izmir Tepecik Education and Research Hospital, Turkey
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22
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Taylor KL, Luta G, Hoffman RM, Davis KM, Lobo T, Zhou Y, Leimpeter A, Shan J, Jensen RE, Aaronson DS, Van Den Eeden SK. Quality of life among men with low-risk prostate cancer during the first year following diagnosis: the PREPARE prospective cohort study. Transl Behav Med 2018; 8:156-165. [PMID: 29425377 DOI: 10.1093/tbm/ibx005] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
As many as 40% of men diagnosed with prostate cancer have low-risk disease, which results in the need to decide whether to undergo active treatment (AT) or active surveillance (AS). The treatment decision can have a significant effect on general and prostate-specific quality of life (QOL). The purpose of this study was to assess the QOL among men with low-risk prostate cancer during the first year following diagnosis. In a prospective cohort study, we conducted pretreatment telephone interviews (N = 1,139; 69.3% response rate) with low-risk PCa patients (PSA ≤ 10, Gleason ≤ 6) and a follow-up assessment 6-10 months postdiagnosis (N = 1057; 93%). We assessed general depression, anxiety, and physical functioning, prostate-specific anxiety, and prostate-specific QOL at both interviews. Clinical variables were obtained from the medical record. Men were 61.7 (SD = 7.2) years old, 82% white, 39% had undergone AT (surgery or radiation), and 61.0% had begun AS. Linear regression analyses revealed that at follow-up, the AS group reported significantly better sexual, bowel, urinary, and general physical function (compared to AT), and no difference in depression. However, the AS group did report greater general anxiety and prostate-specific anxiety at follow-up, compared to AT. Among men with low-risk PCa, adjusting for pretreatment functioning, the AS group reported better prostate-related QOL, but were worse off on general and prostate-specific anxiety compared to men on AT. These results suggest that, within the first year postdiagnosis, men who did not undergo AT may require additional support in order to remain comfortable with this decision and to continue with AS when it is clinically indicated.
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Affiliation(s)
- Kathryn L Taylor
- Cancer Prevention and Control Program, Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC, USA
| | - George Luta
- Department of Biostatistics, Bioinformatics, and Biomathematics, Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC, USA
| | - Richard M Hoffman
- Division of General Internal Medicine, University of Iowa Carver College of Medicine/Iowa City VA Medical Center, Iowa City, IA, USA.,Holden Comprehensive Cancer, University of Iowa, Iowa City, IA, USA
| | - Kimberly M Davis
- Cancer Prevention and Control Program, Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC, USA
| | - Tania Lobo
- Cancer Prevention and Control Program, Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC, USA
| | - Yingjun Zhou
- Cancer Prevention and Control Program, Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC, USA
| | - Amethyst Leimpeter
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA
| | - Jun Shan
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA
| | - Roxanne E Jensen
- Cancer Prevention and Control Program, Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC, USA
| | - David S Aaronson
- Department of Urology, Kaiser Permanente East Bay, Oakland, CA, USA
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23
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Demirel CH, Altok M, Davis JW. Focal therapy for localized prostate cancer: is there a "middle ground" between active surveillance and definitive treatment? Asian J Androl 2018; 21:240302. [PMID: 30178774 PMCID: PMC6337958 DOI: 10.4103/aja.aja_64_18] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2018] [Accepted: 06/12/2018] [Indexed: 01/02/2023] Open
Abstract
In recent years, it has come a long way in the diagnosis, treatment, and follow-up of prostate cancer. Beside this, it was argued that definitive treatments could cause overtreatment, particularly in the very low, low, and favorable risk group. When alternative treatment and follow-up methods are being considered for this group of patients, active surveillance is seen as a good alternative for patients with very low and low-risk groups in this era. However, it has become necessary to find other alternatives for patients in the favorable risk group or patients who cannot adopt active follow-up. In the light of technological developments, the concept of focal therapy was introduced with the intensification of research to treat only the lesioned area instead of treating the entire organ for prostate lesions though there are not many publications about many of them yet. According to the initial results, it was understood that the results could be good if the appropriate focal therapy technique was applied to the appropriate patient. Thus, focal therapies have begun to find their "middle ground" place between definitive therapies and active follow-up.
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Affiliation(s)
- Cihan H Demirel
- Department of Urology, The University of Texas MD Anderson Cancer Center, Houston, Texas 77030, USA
| | - Muammer Altok
- Department of Urology, The University of Texas MD Anderson Cancer Center, Houston, Texas 77030, USA
| | - John W Davis
- Department of Urology, The University of Texas MD Anderson Cancer Center, Houston, Texas 77030, USA
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24
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Modi PK, Kaufman SR, Qi J, Lane BR, Cher ML, Miller DC, Hollenbeck BK, Shahinian VB, Dupree JM. National Trends in Active Surveillance for Prostate Cancer: Validation of Medicare Claims-based Algorithms. Urology 2018; 120:96-102. [PMID: 29990573 DOI: 10.1016/j.urology.2018.06.037] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2018] [Revised: 06/11/2018] [Accepted: 06/18/2018] [Indexed: 02/05/2023]
Abstract
OBJECTIVE To better describe the real-world use of active surveillance. Active surveillance is a preferred management option for low-risk prostate cancer, yet its use outside of high-volume institutions is poorly understood. We created multiple claims-based algorithms, validated them using a robust clinical registry, and applied them to Medicare claims to describe national utilization. MATERIALS AND METHODS We identified men with prostate cancer from 2012-2014 in a 100% sample of Michigan Medicare data and linked them with the Michigan Urologic Surgery Improvement Collaborative (MUSIC) registry. Using MUSIC treatment assignment as the standard, we determined the performance of 8 claims-based algorithms to identify men on active surveillance. We selected 3 algorithms (the most sensitive, the most specific, and a balanced algorithm incorporating age and comorbidity) and applied them to a 20% national Medicare sample to describe national trends. RESULTS We identified 1186 men with incident prostate cancer and completely linked data. Eight algorithms were tested with sensitivity ranging from 23.5% to 88.2% and specificity ranging from 93.5% to 99.1%. We found that the use of surveillance for men with incident prostate cancer increased from 2007 to 2014, nationally. However, among all men in the population, there was a large decrease in the rate of prostate cancer diagnosis and an increased or stable rate in the use of active surveillance, depending on the algorithm used. Less than 25% of men on active surveillance underwent a confirmatory prostate biopsy. CONCLUSION We describe the performance of claims-based algorithms to identify active surveillance.
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Affiliation(s)
- Parth K Modi
- Dow Division of Health Services Research, Department of Urology, University of Michigan, Ann Arbor, MI.
| | - Samuel R Kaufman
- Dow Division of Health Services Research, Department of Urology, University of Michigan, Ann Arbor, MI.
| | - Ji Qi
- Dow Division of Health Services Research, Department of Urology, University of Michigan, Ann Arbor, MI.
| | - Brian R Lane
- Urologic Oncology, Spectrum Health, Grand Rapids, MI.
| | - Michael L Cher
- Department of Urology, Wayne State University, Detroit, MI.
| | - David C Miller
- Dow Division of Health Services Research, Department of Urology, University of Michigan, Ann Arbor, MI.
| | - Brent K Hollenbeck
- Dow Division of Health Services Research, Department of Urology, University of Michigan, Ann Arbor, MI.
| | - Vahakn B Shahinian
- Division of Nephrology, Department of Medicine, University of Michigan, Ann Arbor, MI.
| | - James M Dupree
- Dow Division of Health Services Research, Department of Urology, University of Michigan, Ann Arbor, MI.
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25
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Taneja SS. Re: Comparative Analysis of Biopsy Upgrading in Four Prostate Cancer Active Surveillance Cohorts. J Urol 2018; 199:1112-1113. [PMID: 29677900 DOI: 10.1016/j.juro.2018.02.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/09/2018] [Indexed: 10/18/2022]
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26
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Tsang CF, Lai TCT, Lam W, Ho BSH, Ng ATL, Ma WK, Yiu MK, Tsu JHL. Is prostate specific antigen (PSA) density necessary in selecting prostate cancer patients for active surveillance and what should be the cutoff in the Asian population? Prostate Int 2018; 7:73-77. [PMID: 31384609 PMCID: PMC6664316 DOI: 10.1016/j.prnil.2018.03.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2018] [Revised: 03/02/2018] [Accepted: 03/06/2018] [Indexed: 01/15/2023] Open
Abstract
Background To investigate the role of Prostate Specific Antigen density (PSAD) in selecting prostate cancer patients for active surveillance (AS) and to determine a cutoff PSAD in identifying adverse pathological outcomes. Methods Data from 287 patients who underwent radical prostatectomy for prostate cancer were retrospectively reviewed. Six different AS protocols, the University of Toronto; Royal Marsden; John Hopkins; University of California San Francisco (UCSF); Memorial Sloan Kettering Cancer Center (MSKCC) and Prostate Cancer Research International: Active Surveillance (PRIAS), were applied to the cohort. Pre-operative demographics and pathological outcomes were analysed. Statistical analyses on the predictive factors of adverse pathological outcomes and significance of PSAD were performed. A cutoff PSAD with best balance between sensitivity and specificity in identifying adverse pathological outcome was determined. Results PSAD predicted adverse pathological outcomes better than Prostate Specific Antigen (PSA) level alone. The PSAD was significantly lower (0.12-0.13 ng/dl/ml) in protocols including PSAD (the John Hopkins and PRIAS) compared with the other four protocols not including PSAD as a selection criteria (0.21-0.25 ng/dl/dl, P = 0.00). PSAD predicted adverse pathological outcomes in all protocols not incorporating PSAD as an inclusion criteria (P = 0.00-0.02). By the receiver operator characteristics curve analysis, it was found that a PSAD level of 0.19 ng/ml/ml had the best balance between sensitivity and specificity in predicting pathological adverse disease (Area under curve = 0.63, P = 0.004). Conclusion PSAD is necessary in selecting prostate cancer patients for active surveillance. It predicts adverse pathological outcomes in patients eligible for active surveillance better than PSA level alone. A PSAD cutoff at 0.19 ng/ml/ml has the best balance between sensitivity and specificity in predicting pathological adverse disease. We recommend using AS protocol incorporating PSAD as a selection criteria (in particular the PRIAS protocol with a cutoff PSAD at 0.2 ng/ml/ml) when recruiting prostate cancer patients for AS.
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Affiliation(s)
- Chiu-Fung Tsang
- Division of Urology, Department of Surgery, Queen Mary Hospital, The University of Hong Kong, Hong Kong
| | - Terence C T Lai
- Division of Urology, Department of Surgery, Queen Mary Hospital, The University of Hong Kong, Hong Kong
| | - Wayne Lam
- Division of Urology, Department of Surgery, Queen Mary Hospital, The University of Hong Kong, Hong Kong
| | - Brian S H Ho
- Division of Urology, Department of Surgery, Queen Mary Hospital, The University of Hong Kong, Hong Kong
| | - Ada T L Ng
- Division of Urology, Department of Surgery, Queen Mary Hospital, The University of Hong Kong, Hong Kong
| | - Wai-Kit Ma
- Division of Urology, Department of Surgery, Queen Mary Hospital, The University of Hong Kong, Hong Kong
| | - Ming-Kwong Yiu
- Division of Urology, Department of Surgery, Queen Mary Hospital, The University of Hong Kong, Hong Kong
| | - James H L Tsu
- Division of Urology, Department of Surgery, Queen Mary Hospital, The University of Hong Kong, Hong Kong
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27
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McIlwain DW, Fishel ML, Boos A, Kelley MR, Jerde TJ. APE1/Ref-1 redox-specific inhibition decreases survivin protein levels and induces cell cycle arrest in prostate cancer cells. Oncotarget 2017. [PMID: 29541389 PMCID: PMC5834255 DOI: 10.18632/oncotarget.23493] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
A key feature of prostate cancer progression is the induction and activation of survival proteins, including the Inhibitor of Apoptosis (IAP) family member survivin. Apurinic/apyrimidinic endonuclease 1/redox effector factor 1 (APE1/Ref-1) is a multifunctional protein that is essential in activating oncogenic transcription factors. Because APE1/Ref-1 is expressed and elevated in prostate cancer, we sought to characterize APE1/Ref-1 expression and activity in human prostate cancer cell lines and determine the effect of selective reduction-oxidation (redox) function inhibition on prostate cancer cells in vitro and in vivo. Due to the role of oncogenic transcriptional activators NFĸB and STAT3 in survivin protein expression, and APE1/Ref-1 redox activity regulating their transcriptional activity, we assessed selective inhibition of APE1/Ref-1’s redox function as a novel method to halt prostate cancer cell growth and survival. Our study demonstrates that survivin and APE1/Ref-1 are significantly higher in human prostate cancer specimens compared to noncancerous controls and that APE1/Ref-1 redox-specific inhibition with small molecule inhibitor, APX3330 and a second-generation inhibitor, APX2009, decreases prostate cancer cell proliferation and induces cell cycle arrest. Inhibition of APE1/Ref-1 redox function significantly reduced NFĸB transcriptional activity, survivin mRNA and survivin protein levels. These data indicate that APE1/Ref-1 is a key regulator of survivin and a potentially viable target in prostate cancer.
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Affiliation(s)
- David W McIlwain
- Department of Pharmacology and Toxicology, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Melissa L Fishel
- Department of Pharmacology and Toxicology, Indiana University School of Medicine, Indianapolis, Indiana, USA.,Department of Pediatrics, Herman B Wells Center for Pediatric Research, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Alexander Boos
- Department of Pharmacology and Toxicology, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Mark R Kelley
- Department of Pharmacology and Toxicology, Indiana University School of Medicine, Indianapolis, Indiana, USA.,Department of Pediatrics, Herman B Wells Center for Pediatric Research, Indiana University School of Medicine, Indianapolis, Indiana, USA.,Department of Biochemistry and Molecular Biology, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Travis J Jerde
- Department of Pharmacology and Toxicology, Indiana University School of Medicine, Indianapolis, Indiana, USA
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28
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Yoo S, Son H, Oh S, Park J, Cho SY, Cho MC, Jeong H. A novel biopsy-related parameter derived from location and relationship of positive cores on standard 12-core trans-rectal ultrasound-guided prostate biopsy: a useful parameter for predicting tumor volume compared to number of positive cores. J Cancer Res Clin Oncol 2017; 144:135-143. [PMID: 28939976 DOI: 10.1007/s00432-017-2525-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2017] [Accepted: 09/17/2017] [Indexed: 11/27/2022]
Abstract
PURPOSE To develop a novel biopsy-related parameter, named overlapping line, defined as the line between the adjacent positive cores on 12-core trans-rectal ultrasound-guided prostate biopsy, and evaluated the value of overlapping line for predicting tumor volume in the final pathologic examination. METHODS Among patients with prostate cancer who underwent radical prostatectomy at Boramae Medical Center, 470 patients who underwent standard 12-core trans-rectal ultrasound-guided prostate biopsy were selected for the analysis. The number of overlapping line was determined in each patient, and its effects on tumor volume were evaluated after adjusting for other variables. RESULTS Median prostate specific antigen level was 9.1 ng/mL, and the maximum % cancer in positive cores was 42.8%. Median numbers of positive cores and overlapping lines were three and two, respectively. The pathologic stage was T2 or less, T3a, and T3b or greater in 297 (63.5%), 104 (22.2%), and 67 patients (14.3%), respectively. Median tumor volume in prostatectomy specimen was 3.4 mL. In multivariable analysis, the number of overlapping lines (B 0.750, p < 0.001) was a significant predictor for tumor volume, in addition to prostate specific antigen level and maximum % cancer in positive cores. In addition, the model with overlapping line showed superior accuracy compared to the model with positive core based adjusted r 2 (0.467 vs. 0.456). CONCLUSIONS The number of overlapping lines, a novel prostate biopsy-related variable, is thought to be a more reliable predictor for tumor volume compared to the number of positive cores and could be easily applied to routine daily practice.
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Affiliation(s)
- Sangjun Yoo
- Department of Urology, Seoul National University College of Medicine, Boramae Medical Center, Sindaebang 2(i)-Dong, Dongjak-gu, Seoul, 07061, Korea
| | - Hwancheol Son
- Department of Urology, Seoul National University College of Medicine, Boramae Medical Center, Sindaebang 2(i)-Dong, Dongjak-gu, Seoul, 07061, Korea
| | - Sohee Oh
- Department of Biostatistics, Seoul National University Boramae Medical Center, Seoul, Korea
| | - Juhyun Park
- Department of Urology, Seoul National University College of Medicine, Boramae Medical Center, Sindaebang 2(i)-Dong, Dongjak-gu, Seoul, 07061, Korea
| | - Sung Yong Cho
- Department of Urology, Seoul National University College of Medicine, Boramae Medical Center, Sindaebang 2(i)-Dong, Dongjak-gu, Seoul, 07061, Korea
| | - Min Chul Cho
- Department of Urology, Seoul National University College of Medicine, Boramae Medical Center, Sindaebang 2(i)-Dong, Dongjak-gu, Seoul, 07061, Korea
| | - Hyeon Jeong
- Department of Urology, Seoul National University College of Medicine, Boramae Medical Center, Sindaebang 2(i)-Dong, Dongjak-gu, Seoul, 07061, Korea.
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29
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Parikh RR, Kim S, Stein MN, Haffty BG, Kim IY, Goyal S. Trends in active surveillance for very low-risk prostate cancer: do guidelines influence modern practice? Cancer Med 2017; 6:2410-2418. [PMID: 28925011 PMCID: PMC5633554 DOI: 10.1002/cam4.1132] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2016] [Revised: 05/25/2017] [Accepted: 05/26/2017] [Indexed: 11/30/2022] Open
Abstract
As recommended by current NCCN guidelines, patients with very low‐risk prostate cancer may be treated with active surveillance (AS), but this may be underutilized. Using the National Cancer Database (NCDB), we identified men (2010–2013) with biopsy‐proven, very low‐risk prostate cancer that met AS criteria as suggested by Epstein (stage ≤ T1c; Gleason score (GS) ≤ 6; PSA < 10; and ≤2 [or <33%] positive biopsy cores) and aged ≤76, and low comorbidity index (Charlson‐Deyo score = 0). For those patients meeting this criteria, we performed generalized estimation equation (GEE) method with incorporation of correlation in patients clustered within facility to determine the likelihood of undergoing AS. Among the 448 773 patients in the NCDB with low‐risk prostate cancer, 40 839 patients met the inclusion criteria. AS was utilized in 5798 patients (14.2%), while within the very low‐risk patients receiving treatment, up to 52.2% received radical prostatectomy. In univariate analyses, AS utilization was associated with older age, uninsured status (compared to private insurance), farther distance from facility, academic/research institutions and particularly in the New England region (all P < 0.01). After adjustments of other predictors in multivariate analysis, patients preferentially received AS if they were older (all OR's > 1 compared to younger groups), uninsured (vs. any insurance type, OR's > 1); or treated at academic/research center (OR > 1). The overall use of AS increased from 11.6% (2010) to 27.3% (2013). We found a low, but rising rate of AS in a nationally representative group of very low‐risk prostate cancer patients. Disparities in the use of AS may be targeted to improve adherence to national guidelines.
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Affiliation(s)
- Rahul R Parikh
- Department of Radiation Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, 08903
| | - Sinae Kim
- Biometrics Division, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, 08903.,Department of Biostatistics, Rutgers School of Public Health, New Brunswick, NJ, 08903
| | - Mark N Stein
- Department of Medical Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, 08903
| | - Bruce G Haffty
- Department of Radiation Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, 08903
| | - Isaac Y Kim
- Department of Urology, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, 08903
| | - Sharad Goyal
- Department of Radiation Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, 08903
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30
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Davis K, Bellini P, Hagerman C, Zinar R, Leigh D, Hoffman R, Aaronson D, Van Den Eeden S, Philips G, Taylor K. Physicians' Perceptions of Factors Influencing the Treatment Decision-making Process for Men With Low-risk Prostate Cancer. Urology 2017; 107:86-95. [PMID: 28454988 PMCID: PMC5880528 DOI: 10.1016/j.urology.2017.02.056] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2016] [Revised: 01/28/2017] [Accepted: 02/08/2017] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To assess physicians' attitudes regarding multiple factors that may influence recommendations for active surveillance (AS) vs active treatment (AT) given the central role physicians play in the treatment decision-making process. MATERIALS AND METHODS We conducted semistructured interviews to assess factors that physicians consider important when recommending AS vs AT, as well as physicians' perceptions of what their patients consider important in the decision. Participants included urologists (N = 11), radiation oncologists (N = 12), and primary care physicians (N = 10) from both integrated and fee-for-service healthcare settings. RESULTS Across the specialties, quantitative data indicated that most physicians reported that their recommendations for AS were influenced by patients' older age, willingness and ability to follow a surveillance protocol, anxiety, comorbidities, life expectancy, and treatment preferences. Qualitative findings highlighted physicians' concerns about malpractice lawsuits, given the possibility of disease progression. Additionally, most physicians noted the role of the healthcare setting, suggesting that financial incentives may be associated with AT recommendations in fee-for-service settings. Finally, most physicians reported spouse or family opposition to AS due to their own anxiety or lack of understanding of AS. CONCLUSION We found that patient and physician preferences, healthcare setting, and family or spouse factors influence physicians' treatment recommendations for men with low-risk PCa. These were consistent themes across physician subspecialties in both an Health Maintenance Organization and in fee-for-service settings.
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Affiliation(s)
- Kimberly Davis
- Department of Oncology, Georgetown University Medical Center, Lombardi Comprehensive Cancer Center, Washington, DC.
| | - Paula Bellini
- Department of Oncology, Georgetown University Medical Center, Lombardi Comprehensive Cancer Center, Washington, DC
| | - Charlotte Hagerman
- Department of Oncology, Georgetown University Medical Center, Lombardi Comprehensive Cancer Center, Washington, DC
| | - Riley Zinar
- Department of Oncology, Georgetown University Medical Center, Lombardi Comprehensive Cancer Center, Washington, DC
| | - Daniel Leigh
- Department of Oncology, Georgetown University Medical Center, Lombardi Comprehensive Cancer Center, Washington, DC
| | - Richard Hoffman
- Division of General Internal Medicine, University of Iowa Carver College of Medicine/Iowa City VA Medical Center, Iowa City, IA
| | - David Aaronson
- Department of Urology, Kaiser Permanente, East Bay, Oakland, CA
| | | | - George Philips
- Department of Medicine, MedStar Georgetown University Hospital Center, Washington, DC
| | - Kathryn Taylor
- Department of Oncology, Georgetown University Medical Center, Lombardi Comprehensive Cancer Center, Washington, DC
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31
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Persaud S, Goetz L, Burnett A. Active surveillance for prostate cancer: Is it ready for primetime in the Caribbean? AFRICAN JOURNAL OF UROLOGY 2017. [DOI: 10.1016/j.afju.2016.07.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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32
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Jeong CW, Hong SK, Byun SS, Jeon SS, Seo SI, Lee HM, Ahn H, Kwon DD, Ha HK, Kwon TG, Chung JS, Kwak C, Kim HJ. Selection Criteria for Active Surveillance of Patients with Prostate Cancer in Korea: A Multicenter Analysis of Pathology after Radical Prostatectomy. Cancer Res Treat 2017; 50:265-274. [PMID: 28421726 PMCID: PMC5784641 DOI: 10.4143/crt.2016.477] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2016] [Accepted: 04/06/2017] [Indexed: 11/21/2022] Open
Abstract
Purpose Korean patients with prostate cancer (PC) typically present with a more aggressive disease than patients in Western populations. Consequently, it is unclear if the current criteria for active surveillance (AS) can safely be applied to Korean patients. Therefore, this study was conducted to define appropriate selection criteria for AS for patients with PC in Korea. Materials and Methods We conducted a multicenter retrospective study of 2,126 patients with low risk PC who actually underwent radical prostatectomy. The primary outcome was an unfavorable disease, which was defined by non-organ confined disease or an upgrading of the Gleason score to ≥ 7 (4+3). Predictive variables of an unfavorable outcome were identified by multivariate analysis using randomly selected training samples (n=1,623, 76.3%). We compared our selected criteria to various Western criteria for the primary outcome and validated our criteria using the remaining validation sample (n=503, 23.7%). Results A non-organ confined disease rate of 14.9% was identified, with an increase in Gleason score ≥ 7 (4+3) of 8.7% and a final unfavorable disease status of 20.8%. The following criteria were selected: Gleason score ≤ 6, clinical stage T1-T2a, prostate-specific antigen (PSA) ≤ 10 ng/mL, PSA density < 0.15 ng/mL/mL, number of positive cores ≤ 2, and maximum cancer involvement in any one core ≤ 20%. These criteria provided the lowest unfavorable disease rate (11.7%) when compared to Western criteria (13.3%-20.7%), and their validity was confirmed using the validation sample (5.9%). Conclusion We developed AS criteria which are appropriate for Korean patients with PC. Prospective studies using these criteria are now warranted.
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Affiliation(s)
- Chang Wook Jeong
- Department of Urology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Sung Kyu Hong
- Department of Urology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Seok Soo Byun
- Department of Urology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Seong Soo Jeon
- Department of Urology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Seong Il Seo
- Department of Urology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Hyun Moo Lee
- Department of Urology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Hanjong Ahn
- Department of Urology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Dong Deuk Kwon
- Department of Urology, Chonnam National University Hwasun Hospital, Chonnam National University Medical School, Gwangju, Korea
| | - Hong Koo Ha
- Department of Urology, Pusan National University Hospital, Pusan National University School of Medicine, Busan, Korea
| | - Tae Gyun Kwon
- Department of Urology, Kyungpook National University School of Medicine, Daegu, Korea
| | - Jae Seung Chung
- Department of Urology, Inje University Haeundae Paik Hospital, Busan, Korea
| | - Cheol Kwak
- Department of Urology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Hyung Jin Kim
- Department of Urology, Chonbuk National University Medical School, Jeonju, Korea
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Taneja SS. Re: 10-Year Outcomes after Monitoring, Surgery, or Radiotherapy for Localized Prostate Cancer. J Urol 2017. [DOI: 10.1016/j.juro.2017.01.040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Leapman MS, Freedland SJ, Aronson WJ, Kane CJ, Terris MK, Walker K, Amling CL, Carroll PR, Cooperberg MR. Pathological and Biochemical Outcomes among African-American and Caucasian Men with Low Risk Prostate Cancer in the SEARCH Database: Implications for Active Surveillance Candidacy. J Urol 2016; 196:1408-1414. [PMID: 27352635 PMCID: PMC5542578 DOI: 10.1016/j.juro.2016.06.086] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/03/2016] [Indexed: 01/21/2023]
Abstract
PURPOSE Racial disparities in the incidence and risk profile of prostate cancer at diagnosis among African-American men are well reported. However, it remains unclear whether African-American race is independently associated with adverse outcomes in men with clinical low risk disease. MATERIALS AND METHODS We retrospectively analyzed the records of 895 men in the SEARCH (Shared Equal Access Regional Cancer Hospital) database in whom clinical low risk prostate cancer was treated with radical prostatectomy. Associations of African-American and Caucasian race with pathological biochemical recurrence outcomes were examined using chi-square, logistic regression, log rank and Cox proportional hazards analyses. RESULTS We identified 355 African-American and 540 Caucasian men with low risk tumors in the SEARCH cohort who were followed a median of 6.3 years. Following adjustment for relevant covariates African-American race was not significantly associated with pathological upgrading (OR 1.33, p = 0.12), major upgrading (OR 0.58, p = 0.10), up-staging (OR 1.09, p = 0.73) or positive surgical margins (OR 1.04, p = 0.81). Five-year recurrence-free survival rates were 73.4% in African-American men and 78.4% in Caucasian men (log rank p = 0.18). In a Cox proportional hazards analysis model African-American race was not significantly associated with biochemical recurrence (HR 1.11, p = 0.52). CONCLUSIONS In a cohort of patients at clinical low risk who were treated with prostatectomy in an equal access health system with a high representation of African-American men we observed no significant differences in the rates of pathological upgrading, up-staging or biochemical recurrence. These data support continued use of active surveillance in African-American men. Upgrading and up-staging remain concerning possibilities for all men regardless of race.
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Affiliation(s)
- Michael S Leapman
- Department of Urology, Helen Diller Family Comprehensive Cancer Center, University of California-San Francisco, San Francisco, California.
| | | | - William J Aronson
- Department of Urology, University of California-Los Angeles Medical Center, Los Angeles, California
| | - Christopher J Kane
- Department of Urology, University of California-San Diego Health System, San Diego, California
| | - Martha K Terris
- Department of Urology, Georgia Regents Health System, Augusta, Georgia
| | - Kelly Walker
- Department of Urology, Helen Diller Family Comprehensive Cancer Center, University of California-San Francisco, San Francisco, California
| | | | - Peter R Carroll
- Department of Urology, Helen Diller Family Comprehensive Cancer Center, University of California-San Francisco, San Francisco, California
| | - Matthew R Cooperberg
- Department of Urology, Helen Diller Family Comprehensive Cancer Center, University of California-San Francisco, San Francisco, California; Department of Epidemiology and Biostatistics, University of California-San Francisco, San Francisco, California
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Holtz JN, Tay KJ, Polascik TJ, Gupta RT. Integration of multiparametric MRI into active surveillance of prostate cancer. Future Oncol 2016; 12:2513-2529. [DOI: 10.2217/fon-2016-0142] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Prostate cancer is the most common noncutaneous cancer in men though many men will not die of this disease and may not require definitive treatment. Active surveillance (AS) is an increasingly utilized potential solution to the issue of overtreatment of prostate cancer. Traditionally, prostate cancer patients have been stratified into risk groups based on clinical stage on digital rectal examination, prostate-specific antigen and biopsy Gleason score, though each of these variables has significant limitations. This review will discuss the potential role for prostate multiparametric MRI and targeted biopsy techniques incorporating MRI in the selection of candidates for AS, monitoring patients on AS and as triggers for definitive treatment.
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Affiliation(s)
- Jamie N Holtz
- Duke University Medical Center, Department of Radiology, DUMC Box 3808, Durham, NC 27710, USA
| | - Kae Jack Tay
- Duke University Medical Center, Department of Surgery, Division of Urologic Surgery & Duke Prostate Center, DUMC Box 2804, Durham, NC 27710, USA
| | - Thomas J Polascik
- Duke University Medical Center, Department of Surgery, Division of Urologic Surgery & Duke Prostate Center, DUMC Box 2804, Durham, NC 27710, USA
- Duke Cancer Institute, DUMC Box 3494, 20 Duke Medicine Circle, Durham, NC 27710, USA
| | - Rajan T Gupta
- Duke University Medical Center, Department of Radiology, DUMC Box 3808, Durham, NC 27710, USA
- Duke Cancer Institute, DUMC Box 3494, 20 Duke Medicine Circle, Durham, NC 27710, USA
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Knighton AJ, Belnap T, Brunisholz K, Huynh K, Bishoff JT. Using Electronic Health Record Data to Identify Prostate Cancer Patients That May Qualify for Active Surveillance. EGEMS 2016; 4:1220. [PMID: 27683663 PMCID: PMC5019322 DOI: 10.13063/2327-9214.1220] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Introduction: The introduction of the protein-specific antigen (PSA) test in care means that prostate cancer (PCa) is being detected earlier and more frequently. The result of increased screening using PSA, digital rectal examination and awareness of prostate was an increase in the number of men with low risk cancers. Active surveillance has become a viable alternative to immediate treatment with surgery, radiation and other forms of localized treatment. Evidence suggests that there is no significant difference in mortality rates between AS and surgery. In addition, patients may potentially delay other complications associated with surgery, radiation or deprivation therapy. Methods: This quality improvement study using a delivery system science framework describes the electronic identification of AS candidates given an evidence-based identification criteria based upon national guidelines and clinical judgement. The study population (n=649) was drawn from health records of all patients who received a prostate biopsy (n=1731) at Intermountain Healthcare from 1/1/2013 to 12/31/2014. Automated and manual abstraction was performed. Receiver operating characteristic (ROC) analysis was used to compare AS-eligible patients to the actual treatment received to identify potential care improvement opportunities. Among those with complete data, 24.7% of this population (n=160) met “AS-eligible” criteria. 39.1% of the population had not received surgery, radiation or androgen deprivation therapy and were considered as being treated using an AS approach. 9% of AS-eligible patients did not receive AS; 27% of patients who did not meet AS-eligible criteria received AS. Estimated guideline adherence measured using area under the curve was 0.70 (95% CI: 0.66–0.73). Modest variation in criteria parameters for identifying AS-eligible patients did not significantly change estimated adherence levels. Conclusion: Implementation of evidence-based criteria for detection of AS candidates is feasible using electronic health record data and provides a reasonable basis for delivery system evaluation of practice patterns and for quality improvement.
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Characteristics of Anteriorly Located Prostate Cancer and the Usefulness of Multiparametric Magnetic Resonance Imaging for Diagnosis. J Urol 2016; 196:367-73. [DOI: 10.1016/j.juro.2016.03.075] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/06/2016] [Indexed: 11/19/2022]
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Komisarenko M, Timilshina N, Richard PO, Alibhai SMH, Hamilton R, Kulkarni G, Zlotta A, Fleshner N, Finelli A. Stricter Active Surveillance Criteria for Prostate Cancer do Not Result in Significantly Better Outcomes: A Comparison of Contemporary Protocols. J Urol 2016; 196:1645-1650. [PMID: 27350077 DOI: 10.1016/j.juro.2016.06.083] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/21/2016] [Indexed: 10/21/2022]
Abstract
PURPOSE We reviewed various existing active surveillance criteria and determined the competing trade-offs of the stricter vs more inclusive active surveillance criteria. MATERIALS AND METHODS Men enrolled in an active surveillance program at Princess Margaret Cancer Centre between 1998 and 2014 were identified through a prospectively maintained database. All patients were assessed for entry eligibility into the Prostate Cancer Research International: Active Surveillance, Johns Hopkins, University of Miami, University of California San Francisco, Memorial Sloan Kettering Cancer Center, University of Toronto-Sunnybrook and Royal Marsden protocols. The 2-sided t-test, ANOVA, Wilcoxon rank sum or chi-square tests were used for comparison as appropriate. RESULTS Of the 1,365 men identified 1,085 met the Princess Margaret Cancer Centre inclusion criteria. When the Johns Hopkins, Prostate Cancer Research International: Active Surveillance and University of Miami criteria were applied 15.2%, 11.5% and 11.3% of these patients were excluded from active surveillance, respectively. No significant differences were noted between men who met the Princess Margaret Cancer Centre criteria and those who were excluded based on more stringent criteria when grade or volume reclassification was compared. No significant differences in prostate specific antigen velocity or the number of patients who proceeded to seek treatment were noted (p >0.1). Rates of biochemical recurrence among patients who chose to undergo radical prostatectomy after initial active surveillance were not different between men who met the more inclusive vs more exclusive active surveillance protocols. CONCLUSIONS More selective criteria do not significantly improve short-term outcomes when considering the relative risk of grade reclassification or biochemical failure after treatment. In an era of increased awareness regarding the over diagnosis and overtreatment of prostate cancer, we believe that stricter entry criteria should be reconsidered.
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Affiliation(s)
- Maria Komisarenko
- Division of Urology, Departments of Surgery and Surgical Oncology, Princess Margaret Cancer Centre, University Health Network and the University of Toronto, Toronto, Ontario, Canada
| | - Narhari Timilshina
- Division of Urology, Departments of Surgery and Surgical Oncology, Princess Margaret Cancer Centre, University Health Network and the University of Toronto, Toronto, Ontario, Canada
| | - Patrick O Richard
- Division of Urology, Departments of Surgery and Surgical Oncology, Princess Margaret Cancer Centre, University Health Network and the University of Toronto, Toronto, Ontario, Canada
| | - Shabbir M H Alibhai
- Department of Medicine, University Health Network and the University of Toronto, Toronto, Ontario, Canada
| | - Robert Hamilton
- Division of Urology, Departments of Surgery and Surgical Oncology, Princess Margaret Cancer Centre, University Health Network and the University of Toronto, Toronto, Ontario, Canada
| | - Girish Kulkarni
- Division of Urology, Departments of Surgery and Surgical Oncology, Princess Margaret Cancer Centre, University Health Network and the University of Toronto, Toronto, Ontario, Canada
| | - Alexandre Zlotta
- Division of Urology, Departments of Surgery and Surgical Oncology, Princess Margaret Cancer Centre, University Health Network and the University of Toronto, Toronto, Ontario, Canada
| | - Neil Fleshner
- Division of Urology, Departments of Surgery and Surgical Oncology, Princess Margaret Cancer Centre, University Health Network and the University of Toronto, Toronto, Ontario, Canada
| | - Antonio Finelli
- Division of Urology, Departments of Surgery and Surgical Oncology, Princess Margaret Cancer Centre, University Health Network and the University of Toronto, Toronto, Ontario, Canada.
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Hwang I, Lim D, Jeong YB, Park SC, Noh JH, Kwon DD, Kang TW. Upgrading and upstaging of low-risk prostate cancer among Korean patients: a multicenter study. Asian J Androl 2016; 17:811-4. [PMID: 25578934 PMCID: PMC4577596 DOI: 10.4103/1008-682x.143751] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Only 54% of prostate cancer cases in Korea are localized compared with 82% of cases in the US. Furthermore, half of Korean patients are upgraded after radical prostatectomy (41.6%–50.6%). We investigated the risk factors for upgrading and/or upstaging of low-risk prostate cancer after radical prostatectomy. We retrospectively reviewed the medical records of 1159 patients who underwent radical prostatectomy at five hospitals in Honam Province. Preoperative data on standard clinicopathological parameters were collected. The radical prostatectomy specimens were graded and staged and we defined a “worsening prognosis” as a Gleason score ≥ 7 or upstaging to ≥ pT3. Multivariate logistic regression models were used to assess factors associated with postoperative pathological upstaging. Among the 1159 patients, 324 were classified into the clinically low-risk group, and 154 (47.5%) patients were either upgraded or upstaged. The multivariable analysis revealed that the preoperative serum prostate-specific antigen level (odds ratio [OR], 1.131; 95% confidence interval [CI], 1.007–1.271; P= 0.037), percent positive biopsy core (OR: 1.018; 95% CI: 1.002–1.035; P= 0.032), and small prostate volume (≤30 ml) (OR: 2.280; 95% CI: 1.351–3.848; P= 0.002) were predictive of a worsening prognosis. Overall, 47.5% of patients with low-risk disease were upstaged postoperatively. The current risk stratification criteria may be too relaxed for our study cohort.
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Affiliation(s)
| | | | | | | | | | | | - Taek Won Kang
- Department of Urology, Chonnam National University Medical School, Gwangju, Korea
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40
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Further reduction of disqualification rates by additional MRI-targeted biopsy with transperineal saturation biopsy compared with standard 12-core systematic biopsies for the selection of prostate cancer patients for active surveillance. Prostate Cancer Prostatic Dis 2016; 19:283-91. [DOI: 10.1038/pcan.2016.16] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2015] [Revised: 10/15/2015] [Accepted: 11/11/2015] [Indexed: 12/28/2022]
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41
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Predictive Factors for Reclassification and Relapse in Prostate Cancer Eligible for Active Surveillance: A Systematic Review and Meta-analysis. Urology 2016; 91:136-42. [DOI: 10.1016/j.urology.2016.01.034] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2015] [Revised: 01/04/2016] [Accepted: 01/28/2016] [Indexed: 11/22/2022]
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42
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Scarpato KR, Barocas DA. Use of mpMRI in active surveillance for localized prostate cancer. Urol Oncol 2016; 34:320-5. [PMID: 27036218 DOI: 10.1016/j.urolonc.2016.02.020] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2016] [Revised: 02/21/2016] [Accepted: 02/26/2016] [Indexed: 10/22/2022]
Abstract
INTRODUCTION In an effort to limit prostate cancer (PCa) overdiagnosis and overtreatment, which have occurred in response to widespread prostate specific antigen testing, numerous strategies aimed at improved risk stratification of patients with PCa have evolved. Multiparametric magnetic resonance imaging (MRI) is being used in concert with prostate specific antigen testing and prostate biopsies to improve sensitivity and specificity of these tests. There are limited data on how multiparametric MRI can be incorporated into active surveillance (AS) protocols. EVIDENCE ACQUISITION A PubMed literature search of available English language publications on PCa, AS, and MRI was conducted. Appropriate articles were selected and included for review. Bibliographies were also used to expand our search. EVIDENCE SYNTHESIS Data from 41 studies were reviewed. AS inclusion criteria and protocols varied among studies, as did indications for use of MRI. Technological improvements are briefly highlighted. Studies are broadly categorized and discussed according to the role of MRI in patient selection, disease staging, and monitoring in AS protocols. CONCLUSIONS Although improvements in MRI technology have been useful for biopsy guidance and in the diagnosis and staging of PCa, this literature search demonstrates that more prospective research is needed, specifically regarding how this promising technology can be incorporated into AS protocols.
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Affiliation(s)
- Kristen R Scarpato
- Department of Urologic Surgery, Vanderbilt University Medical Center, A-1302 Medical Center North, Nashville TN 37232.
| | - Daniel A Barocas
- Department of Urologic Surgery, Vanderbilt University Medical Center, A-1302 Medical Center North, Nashville TN 37232
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Filson CP, Natarajan S, Margolis DJA, Huang J, Lieu P, Dorey FJ, Reiter RE, Marks LS. Prostate cancer detection with magnetic resonance-ultrasound fusion biopsy: The role of systematic and targeted biopsies. Cancer 2016; 122:884-92. [PMID: 26749141 DOI: 10.1002/cncr.29874] [Citation(s) in RCA: 302] [Impact Index Per Article: 37.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2015] [Revised: 12/02/2015] [Accepted: 12/14/2015] [Indexed: 11/12/2022]
Abstract
BACKGROUND The current study was conducted to evaluate the performance of magnetic resonance (MR)-ultrasound-guided fusion biopsy in diagnosing clinically significant prostate cancer (csCaP). METHODS A total of 1042 men underwent multiparametric MR imaging (mpMRI) and fusion biopsy consecutively in a prospective trial (2009-2014). An expert reader graded mpMRI regions of interest (ROIs) as 1 to 5 using published protocols. The fusion biopsy device was used to obtain targeted cores from ROIs (when present) followed by a fusion image-guided, 12-core systematic biopsy in all men, even if no suspicious ROI was noted. The primary endpoint of the study was the detection of csCaP (ie, Gleason score ≥ 7). RESULTS Among 825 men with ≥ 1 suspicious ROI of ≥ grade 3, 289 (35%) were found to have csCaP. Powerful predictors of csCaP were ROI grade (grade 5 vs grade 3: odds ratio, 6.5 [P<.01]) and prostate-specific antigen density (each increase of 0.05 ng/mL/cc: odds ratio, 1.4 [P<.01]). Combining systematic and targeted biopsies resulted in the detection of more patients with csCaP (289 patients) than targeting (229 patients) or systematic (199 patients) biopsy alone. Among patients with no suspicious ROI, 35 (16%) were found to have csCaP on systematic biopsy. CONCLUSIONS In this prospective trial, MR-ultrasound fusion biopsy allowed for the detection of csCaP, with a direct relationship noted with ROI grade and prostate-specific antigen density. The combination of targeted and systematic biopsy detected more csCaP than either modality alone; systematic biopsies revealed csCaP in 16% of men with no suspicious MRI target. The advantages of this new biopsy method are apparent, but issues of cost, training, and reliability await resolution before its widespread adoption.
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Affiliation(s)
- Christopher P Filson
- Department of Urology, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, California.,Department of Urology, Emory University, Atlanta, Georgia
| | - Shyam Natarajan
- Department of Urology, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, California.,Center for Advanced Surgical and Interventional Technology, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, California
| | - Daniel J A Margolis
- Department of Radiology, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, California
| | - Jiaoti Huang
- Department of Pathology, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, California
| | - Patricia Lieu
- Department of Urology, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, California
| | - Frederick J Dorey
- Department of Urology, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, California
| | - Robert E Reiter
- Department of Urology, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, California
| | - Leonard S Marks
- Department of Urology, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, California
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Bokhorst LP, Steyerberg EW, Roobol MJ. Decision Support for Low-Risk Prostate Cancer. Prostate Cancer 2016. [DOI: 10.1016/b978-0-12-800077-9.00024-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Romero-Otero J, García-Gómez B, Duarte-Ojeda JM, Rodríguez-Antolín A, Vilaseca A, Carlsson SV, Touijer KA. Active surveillance for prostate cancer. Int J Urol 2015; 23:211-8. [PMID: 26621054 DOI: 10.1111/iju.13016] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2015] [Accepted: 10/20/2015] [Indexed: 12/20/2022]
Abstract
It is worth distinguishing between the two strategies of expectant management for prostate cancer. Watchful waiting entails administering non-curative androgen deprivation therapy to patients on development of symptomatic progression, whereas active surveillance entails delivering curative treatment on signs of disease progression. The objectives of the two management strategies and the patients enrolled in either are different: (i) to review the role of active surveillance as a management strategy for patients with low-risk prostate cancer; and (ii) review the benefits and pitfalls of active surveillance. We carried out a systematic review of active surveillance for prostate cancer in the literature using the National Center for Biotechnology Information's electronic database, PubMed. We carried out a search in English using the terms: active surveillance, prostate cancer, watchful waiting and conservative management. Selected studies were required to have a comprehensive description of the demographic and disease characteristics of the patients at the time of diagnosis, inclusion criteria for surveillance, and a protocol for the patients' follow up. Review articles were included, but not multiple papers from the same datasets. Active surveillance appears to reduce overtreatment in patients with low-risk prostate cancer without compromising cancer-specific survival at 10 years. Therefore, active surveillance is an option for select patients who want to avoid the side-effects inherent to the different types of immediate treatment. However, inclusion criteria for active surveillance and the most appropriate method of monitoring patients on active surveillance have not yet been standardized.
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Affiliation(s)
| | | | | | | | - Antoni Vilaseca
- Urology Department, Memorial Sloan Kettering Cancer Center, New York City, New York, USA
| | - Sigrid V Carlsson
- Urology Department, Memorial Sloan Kettering Cancer Center, New York City, New York, USA.,Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Karim A Touijer
- Urology Department, Memorial Sloan Kettering Cancer Center, New York City, New York, USA
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Abstract
In Europe prostate cancer is one of the most common cancers among men. The diagnostics always include a control of the prostate-specific antigen (PSA) level and examination of a representative tissue sample from the prostate. With these findings it is possible to evaluate the degree of progression of the cancer and its prognosis. Several treatment options for localized prostate cancer are given by national and international guidelines including radical prostatectomy, percutaneous radiation therapy, or brachytherapy and surveillance of the cancer with optional treatment at a later stage. For the latter treatment option, known as active surveillance, strict criteria have to be met. The advantage of active surveillance is that only patients with progressive cancer are subjected to radical therapy. Patients with very slow or non-progressing cancer do not have to undergo therapy and thus do not have to suffer from the side effects. The basic idea behind active surveillance is that some cancers will not progress to a stage that requires treatment within the lifetime of the patient and therefore do not require treatment at all. Unfortunately the criteria for active surveillance are not definitive enough at the current time leading only to a delay in effective treatment for many patients. The surveillance strategy has without doubt a high significance among the treatment options for prostate cancer; however, at the current time it lacks reliable indicators for a certain prognosis. Therefore, patients must be informed in detail about the advantages and disadvantages of active surveillance.
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47
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Yamada Y, Sakamoto S, Sazuka T, Goto Y, Kawamura K, Imamoto T, Nihei N, Suzuki H, Akakura K, Ichikawa T. Validation of active surveillance criteria for pathologically insignificant prostate cancer in Asian men. Int J Urol 2015; 23:49-54. [PMID: 26450768 DOI: 10.1111/iju.12952] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2015] [Accepted: 08/26/2015] [Indexed: 01/14/2023]
Abstract
OBJECTIVES To validate the ability of contemporary active surveillance protocols to predict pathologically insignificant prostate cancer among Asian men undergoing radical prostatectomy. METHODS We retrospectively reviewed data on 132 patients eligible for any active surveillance criteria out of 450 patients that underwent radical prostatectomy at several institutions between 2006 and 2013. We validated the ability of seven contemporary active surveillance protocols to predict pathologically insignificant prostate cancer. Traditional and updated criteria to define pathologically insignificant prostate cancer were used. Predictive factors for pathologically insignificant prostate cancer were determined by logistic regression analysis. RESULTS The predictive rate for updated pathologically insignificant prostate cancer of respective active surveillance criteria was 51% for Johns Hopkins Medical Institution, 41% for Prostate Cancer Research International: Active Surveillance Study, 39% for University of Miami, 32% for University of California, San Francisco, 32% for Memorial Sloan-Kettering Cancer Center, 31% for Kakehi and 27% for University of Toronto. Predictive rates for pathologically insignificant prostate cancer in Asian men were far lower than in USA men. On multivariate analysis, predictive factors of updated pathologically insignificant cancer was prostate volume (odds ratio 1.07, P = 0.004). By adding prostate volume to Prostate Cancer Research International: Active Surveillance Study criteria, the predictive rate for updated insignificant prostate cancer was improved up to 66.7%. CONCLUSIONS Active surveillance can be carried out considering the clinical characteristics of prostate cancers depending on ethnicity, as current active surveillance criteria seem to have a lower predictive ability value of insignificant prostate cancer in Asian men compared with men in Western countries.
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Affiliation(s)
- Yasutaka Yamada
- Department of Urology, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Shinichi Sakamoto
- Department of Urology, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Tomokazu Sazuka
- Department of Urology, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Yusuke Goto
- Department of Urology, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Koji Kawamura
- Department of Urology, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Takashi Imamoto
- Department of Urology, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Naoki Nihei
- Department of Urology, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Hiroyoshi Suzuki
- Department of Urology, Toho University Medical Center Sakura Hospital, Sakura, Chiba, Japan
| | - Koichiro Akakura
- Department of Urology, Japan Community Health Care Organization, Tokyo, Japan
| | - Tomohiko Ichikawa
- Department of Urology, Chiba University Graduate School of Medicine, Chiba, Japan
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48
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Active surveillance for low-risk prostate cancer: Need for intervention and survival at 10 years. Urol Oncol 2015; 33:383.e9-16. [DOI: 10.1016/j.urolonc.2015.04.015] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2015] [Revised: 04/17/2015] [Accepted: 04/27/2015] [Indexed: 11/23/2022]
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49
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Radical Prostatectomy Findings in Men on Active Surveillance: Variable Findings Dependent on Reason for Surgery and Entry Criteria. J Urol 2015; 194:685-9. [DOI: 10.1016/j.juro.2015.02.085] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/17/2015] [Indexed: 11/19/2022]
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50
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Abstract
Since the dissemination of prostate-specific antigen screening, most men with prostate cancer are now diagnosed with localized, low-risk prostate cancer that is unlikely to be lethal. Nevertheless, nearly all of these men undergo primary treatment with surgery or radiation, placing them at risk for longstanding side effects, including erectile dysfunction and impaired urinary function. Active surveillance and other observational strategies (ie, expectant management) have produced excellent long-term disease-specific survival and minimal morbidity for men with prostate cancer. Despite this, expectant management remains underused for men with localized prostate cancer. In this review, various approaches to the expectant management of men with prostate cancer are summarized, including watchful waiting and active surveillance strategies. Contemporary cancer-specific and health care quality-of-life outcomes are described for each of these approaches. Finally, contemporary patterns of use, potential disparities in care, and ongoing research and controversies surrounding expectant management of men with localized prostate cancer are discussed.
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Affiliation(s)
- Christopher P Filson
- Health Services Research Fellow, Department of Urology, David Geffen School of Medicine at UCLA, University of California, Los Angeles, Los Angeles, CA
| | - Leonard S Marks
- Professor of Urology, Department of Urology, David Geffen School of Medicine at UCLA, University of California, Los Angeles, Los Angeles, CA
| | - Mark S Litwin
- Chair and Professor of Urology, Department of Urology, David Geffen School of Medicine at UCLA; Professor of Health Services, Department of Health Policy and Management, UCLA Fielding School of Public Health, University of California, Los Angeles, Los Angeles, CA
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