1
|
Soloway MS. Inflection points in urology as witnessed by Mark Soloway Part 2: Prostate and kidney cancers. Cent European J Urol 2023; 76:283-286. [PMID: 38230321 PMCID: PMC10789275 DOI: 10.5173/ceju.2023.3e] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2023] [Revised: 07/16/2023] [Accepted: 07/25/2023] [Indexed: 01/18/2024] Open
Affiliation(s)
- Mark S Soloway
- Division of Urology, Urologic Oncology Memorial Physician Group, Memorial Hospital, Hollywood, United States of America
| |
Collapse
|
2
|
Xue Q, Zhang J, Jiao J, Qin W, Yang X. Photodynamic therapy for prostate cancer: Recent advances, challenges and opportunities. Front Oncol 2022; 12:980239. [PMID: 36212416 PMCID: PMC9538922 DOI: 10.3389/fonc.2022.980239] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Accepted: 09/02/2022] [Indexed: 12/03/2022] Open
Abstract
Over the past two decades, there has been a tendency toward early diagnosis of prostate cancer due to raised awareness among the general public and professionals, as well as the promotion of prostate-specific antigen (PSA) screening. As a result, patients with prostate cancer are detected at an earlier stage. Due to the risks of urine incontinence, erectile dysfunction, etc., surgery is not advised because the tumor is so small at this early stage. Doctors typically only advise active surveillance. However, it will bring negative psychological effects on patients, such as anxiety. And there is a higher chance of cancer progression. Focal therapy has received increasing attention as an alternative option between active monitoring and radical therapy. Due to its minimally invasive, oncological safety, low toxicity, minimal effects on functional outcomes and support by level 1 evidence from the only RCT within the focal therapy literature, photodynamic treatment (PDT) holds significant promise as the focal therapy of choice over other modalities for men with localized prostate cancer. However, there are still numerous obstacles that prevent further advancement. The review that follows provides an overview of the preclinical and clinical published research on PDT for prostate cancer from 1999 to the present. It focuses on clinical applications of PDT and innovative techniques and technologies that address current problems, especially the use of nanoparticle photosensitizers in PDT of prostate cancer.
Collapse
Affiliation(s)
| | - Jingliang Zhang
- Department of Urology, Xijing Hospital, Fourth Military Medical University, Xi’an, China
| | | | - Weijun Qin
- Department of Urology, Xijing Hospital, Fourth Military Medical University, Xi’an, China
| | - Xiaojian Yang
- Department of Urology, Xijing Hospital, Fourth Military Medical University, Xi’an, China
| |
Collapse
|
3
|
Goujon A, Legrand G, Verine J, Hennequin C, Meria P, Mongiat Artus P, Desgrandchamps F, Masson-Lecomte A. [Active surveillance of prostate cancer: treatement-free survival according to restricted or expanded eligibility criteria]. Prog Urol 2020; 30:646-654. [PMID: 32933827 DOI: 10.1016/j.purol.2020.04.005] [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: 07/04/2019] [Revised: 04/04/2020] [Accepted: 04/06/2020] [Indexed: 12/24/2022]
Abstract
AIM Overtreatment is an actual problem in low risk localized prostate cancer (PC) management. Active surveillance (AS) is a solution to limit this problem, but eligibility criteria remained discussed. The aim was to assess possibilities of widening selection criteria for patient in AS, studying curative treatment free survival (CTFS) according to restricted or expanded eligibility criteria. METHODS We retrospectively studied patients beginning AS between 2008 and 2014, for Gleason 6 localized PC, PSA<15ng/ml,<cT3. The group "strict criteria" was defined:≤cT2a, PSA<10ng/ml, 2≤positive biopsies (PB+), total tumoral length≤3mm, tumoral invading≤50%, PSA density≤0,15ng/ml/cm3. MRI was performed at baseline and during follow-up. Radical treatment was proposed in case of biological, histological or clinical progression. Criteria associated with AS survival were analyzed by Cox regression. RESULTS One hundred eighty patients were included (follow-up 46 months). One hundred and eleven patients had "strict" criteria vs. 69 "expanded" criteria. Eighty-two patients (45%) were treated with median time of 18.2 months (CTFS was 71% at 2 years, 52% at 5 years.). The widening of the inclusion criteria was not associated with CTFS (65 vs 54% at 5 years, P=0.13). Factors significatively associated with discontinuation of AS were bilaterality (HR=2.12) and abnormal rectal digital examination cT2 (HR=2,07); MRI target (HR=2,48)) tended towards significance. CONCLUSION Our study concludes that curative treatment free survival is similar for patients included with expanded criteria compared with those included with strict criteria. However, high initial cancer volume) is associated with AS discontinuation. LEVEL OF EVIDENCE 3.
Collapse
Affiliation(s)
- A Goujon
- Service d'urologie, hôpital Saint-Louis, AP-HP, 1, avenue Claude-Vellefaux, 75010 Paris, France.
| | - G Legrand
- Clinique des Jockeys, Chantilly, France
| | - J Verine
- Université Paris-Diderot, Paris, France; Service d'anatomie pathologique, hôpital Saint-Louis, AP-HP, Paris, France
| | - C Hennequin
- Université Paris-Diderot, Paris, France; Service de radiothérapie, hôpital Saint-Louis, AP-HP, Paris, France
| | - P Meria
- Service d'urologie, hôpital Saint-Louis, AP-HP, 1, avenue Claude-Vellefaux, 75010 Paris, France
| | - P Mongiat Artus
- Service d'urologie, hôpital Saint-Louis, AP-HP, 1, avenue Claude-Vellefaux, 75010 Paris, France; Université Paris-Diderot, Paris, France
| | - F Desgrandchamps
- Service d'urologie, hôpital Saint-Louis, AP-HP, 1, avenue Claude-Vellefaux, 75010 Paris, France; Université Paris-Diderot, Paris, France
| | - A Masson-Lecomte
- Service d'urologie, hôpital Saint-Louis, AP-HP, 1, avenue Claude-Vellefaux, 75010 Paris, France; Université Paris-Diderot, Paris, France
| |
Collapse
|
4
|
Rakic N, Keeley J, Abdollah F. Re: Timothy J. Wilt, Tien N. Vo, Lisa Langsetmo, et al. Radical Prostatectomy or Observation for Clinically Localized Prostate Cancer: Extended Follow-up of the Prostate Cancer Intervention Versus Observation Trial (PIVOT). Eur Urol 2020;77:713-724: External Validity of the Updated Prostate Cancer Intervention Versus Observation Trial (PIVOT). Eur Urol Oncol 2020; 3:557-558. [PMID: 32546347 DOI: 10.1016/j.euo.2020.05.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Accepted: 05/13/2020] [Indexed: 11/16/2022]
Affiliation(s)
- Nikola Rakic
- Vattikuti Urology Institute, Henry Ford Hospital, Detroit, MI, USA
| | - Jacob Keeley
- Vattikuti Urology Institute, Henry Ford Hospital, Detroit, MI, USA
| | - Firas Abdollah
- Vattikuti Urology Institute, Henry Ford Hospital, Detroit, MI, USA.
| |
Collapse
|
5
|
Núñez DA, Lu Y, Paudyal R, Hatzoglou V, Moreira AL, Oh JH, Stambuk HE, Mazaheri Y, Gonen M, Ghossein RA, Shaha AR, Tuttle RM, Shukla-Dave A. Quantitative Non-Gaussian Intravoxel Incoherent Motion Diffusion-Weighted Imaging Metrics and Surgical Pathology for Stratifying Tumor Aggressiveness in Papillary Thyroid Carcinomas. ACTA ACUST UNITED AC 2020; 5:26-35. [PMID: 30854439 PMCID: PMC6403039 DOI: 10.18383/j.tom.2018.00054] [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] [Indexed: 12/26/2022]
Abstract
We assessed a priori aggressive features using quantitative diffusion-weighted imaging metrics to preclude an active surveillance management approach in patients with papillary thyroid cancer (PTC) with tumor size 1-2 cm. This prospective study enrolled 24 patients with PTC who underwent pretreatment multi-b-value diffusion-weighted imaging on a GE 3 T magnetic resonance imaging scanner. The apparent diffusion coefficient (ADC) metric was calculated from monoexponential model, and the perfusion fraction (f), diffusion coefficient (D), pseudo-diffusion coefficient (D*), and diffusion kurtosis coefficient (K) metrics were estimated using the non-Gaussian intravoxel incoherent motion model. Neck ultrasonography examination data were used to calculate tumor size. The receiver operating characteristic curve assessed the discriminative specificity, sensitivity, and accuracy between PTCs with and without features of tumor aggressiveness. Multivariate logistic regression analysis was performed on metrics using a leave-1-out cross-validation method. Tumor aggressiveness was defined by surgical histopathology. Tumors with aggressive features had significantly lower ADC and D values than tumors without tumor-aggressive features (P < .05). The absolute relative change was 46% in K metric value between the 2 tumor types. In total, 14 patients were in the critical size range (1-2 cm) measured by ultrasonography, and the ADC and D were significantly different and able to differentiate between the 2 tumor types (P < .05). ADC and D can distinguish tumors with aggressive histological features to preclude an active surveillance management approach in patients with PTC with tumors measuring 1-2 cm.
Collapse
Affiliation(s)
- David Aramburu Núñez
- Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Yonggang Lu
- Department of Radiology, Medical College of Wisconsin, Milwaukee, WI
| | - Ramesh Paudyal
- Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, NY
| | | | - Andre L Moreira
- Department of Pathology, NYU Langone Medical Center, New York, NY
| | - Jung Hun Oh
- Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, NY
| | | | - Yousef Mazaheri
- Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, NY
| | | | | | | | | | - Amita Shukla-Dave
- Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, NY.,Departments of Radiology
| |
Collapse
|
6
|
Hoffman RM, Lobo T, Van Den Eeden SK, Davis KM, Luta G, Leimpeter AD, Aaronson D, Penson DF, Taylor K. Selecting Active Surveillance: Decision Making Factors for Men with a Low-Risk Prostate Cancer. Med Decis Making 2019; 39:962-974. [PMID: 31631745 DOI: 10.1177/0272989x19883242] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background. Men with a low-risk prostate cancer (PCa) should consider observation, particularly active surveillance (AS), a monitoring strategy that avoids active treatment (AT) in the absence of disease progression. Objective. To determine clinical and decision-making factors predicting treatment selection. Design. Prospective cohort study. Setting. Kaiser Permanente Northern California (KPNC). Patients. Men newly diagnosed with low-risk PCa between 2012 and 2014 who remained enrolled in KPNC for 12 months following diagnosis. Measurements. We used surveys and medical record abstractions to measure sociodemographic and clinical characteristics and psychological and decision-making factors. Men were classified as being on observation if they did not undergo AT within 12 months of diagnosis. We performed multivariable logistic regression analyses. Results. The average age of the 1171 subjects was 61.5 years (s = 7.2 years), and 81% were white. Overall, 639 (57%) were managed with observation; in adjusted analyses, significant predictors of observation included awareness of low-risk status (odds ratio 1.75; 95% confidence interval 1.04-2.94), knowing that observation was an option (3.62; 1.62-8.09), having concerns about treatment-related quality of life (1.21, 1.09-1.34), reporting a urologist recommendation for observation (8.20; 4.68-14.4), and having a lower clinical stage (T1c v. T2a, 2.11; 1.16-3.84). Conversely, valuing cancer control (1.54; 1.37-1.72) and greater decisional certainty (1.66; 1.18-2.35) were predictive of AT. Limitations. Results may be less generalizable to other types of health care systems and to more diverse populations. Conclusions. Many participants selected observation, and this was associated with tumor characteristics. However, nonclinical decisional factors also independently predicted treatment selection. Efforts to provide early decision support, particularly targeting knowledge deficits, and reassurance to men with low-risk cancers may facilitate better decision making and increase uptake of observation, particularly AS.
Collapse
Affiliation(s)
- Richard M Hoffman
- Division of General Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, IA, USA.,Holden Comprehensive Cancer Center, University of Iowa, Iowa City, IA, USA
| | - Tania Lobo
- Cancer Prevention and Control Program, Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC, USA
| | | | - Kimberly M Davis
- 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
| | | | - David Aaronson
- Department of Urology, Kaiser Permanente East Bay, Oakland, CA, USA
| | - David F Penson
- Department of Urological Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Kathryn Taylor
- Cancer Prevention and Control Program, Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC, USA
| |
Collapse
|
7
|
Taku N, Narayan V, Wang X, Vapiwala N. Prevalence, Predictors, and Implications for Appropriate Use of Active Surveillance Management Among Black Men Diagnosed With Low-risk Prostate Cancer. Am J Clin Oncol 2019; 42:507-511. [PMID: 31045876 DOI: 10.1097/coc.0000000000000547] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
BACKGROUND Consensus guidelines recommend that active surveillance (AS) be considered in the management of men with low-risk prostate cancer (LRPC). The objective was to evaluate the prevalence and predictors of an AS approach in black men (BM) diagnosed with LRPC after inclusion of AS in LRPC consensus guidelines. MATERIALS AND METHODS BM and white men (WM) diagnosed with LRPC (prostate-specific antigen ≤10 ng/mL, Gleason score [GS] ≤6, clinical stage T1-T2a) between 2010 and 2013 were identified from the National Cancer Database. Logistic regression models were used to assess the likelihood of AS over time and to examine associations between sociodemographic characteristics (SDCs) and the receipt of AS. A subanalysis was performed to assess the likelihood of GS upgrading on prostatectomy specimens for cases that received definitive treatment with radical prostatectomy. RESULTS Overall, 9% of BM (N=15,242) with LRPC were managed with AS. The likelihood of BM undergoing AS increased from 2010 and for all subsequent years of the study period (P<0.001). Uninsured BM were twice as likely as those with private insurance to undergo AS (odds ratio [OR]=1.97; 95% confidence interval [CI], 1.51-2.58; P<0.001). BM were less likely than WM (N=86,655) to receive AS (OR=0.82; 95% CI, 0.77-0.87; P<0.001). However, on multivariate analysis adjusted for SDCs, there was no significant difference in AS utilization between the 2 race groups. Nearly half of BM (47.5%) treated with radical prostatectomy had a postprostatectomy GS≥7, and BM were 17% more likely to experience postprostatectomy upgrading to GS≥7 when compared with WM (OR=1.17; 95% CI, 1.08-1.26; P<0.001). CONCLUSIONS The utilization of AS for BM with LRPC seems to be increasing, is influenced by SDCs, and may not differ from AS utilization among WM. Careful consideration of prostate biopsy technique and sampling as well as SDCs at time of treatment planning may be necessary to ensure adequate evaluation of prostatic disease and appropriate disease management for BM with LRPC.
Collapse
Affiliation(s)
- Nicolette Taku
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | | | - Xingmei Wang
- Biostatistics Analysis Center, University of Pennsylvania, Philadelphia, PA
| | - Neha Vapiwala
- Department of Radiation Oncology, Hospital of the University of Pennsylvania
| |
Collapse
|
8
|
Höffkes F, Arthanareeswaran VKA, Stolzenburg JU, Ganzer R. Rate of misclassification in patients undergoing radical prostatectomy but fulfilling active surveillance criteria according to the European Association of Urology guidelines on prostate cancer: a high-volume center experience. MINERVA UROL NEFROL 2018; 70:588-593. [DOI: 10.23736/s0393-2249.18.03126-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
|
9
|
Kearns JT, Faino AV, Newcomb LF, Brooks JD, Carroll PR, Dash A, Ellis WJ, Fabrizio M, Gleave ME, Morgan TM, Nelson PS, Thompson IM, Wagner AA, Zheng Y, Lin DW. Role of Surveillance Biopsy with No Cancer as a Prognostic Marker for Reclassification: Results from the Canary Prostate Active Surveillance Study. Eur Urol 2018; 73:706-712. [PMID: 29433973 PMCID: PMC6064187 DOI: 10.1016/j.eururo.2018.01.016] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2017] [Accepted: 01/17/2018] [Indexed: 12/24/2022]
Abstract
BACKGROUND Many patients who are on active surveillance (AS) for prostate cancer will have surveillance prostate needle biopsies (PNBs) without any cancer evident. OBJECTIVE To define the association between negative surveillance PNBs and risk of reclassification on AS. DESIGN, SETTING, AND PARTICIPANTS All men were enrolled in the Canary Prostate Active Surveillance Study (PASS) between 2008 and 2016. Men were included if they had Gleason ≤3+4 prostate cancer and <34% core involvement ratio at diagnosis. Men were prescribed surveillance PNBs at 12 and 24 mo after diagnosis and then every 24 mo. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS Reclassification was defined as an increase in Gleason grade and/or an increase in the ratio of biopsy cores to cancer to ≥34%. PNB outcomes were defined as follows: (1) no cancer on biopsy, (2) cancer without reclassification, or (3) reclassification. Kaplan-Meier and Cox proportional hazard models were performed to assess the risk of reclassification. RESULTS AND LIMITATIONS A total of 657 men met inclusion criteria. On first surveillance PNB, 214 (32%) had no cancer, 282 (43%) had cancer but no reclassification, and 161 (25%) reclassified. Among those who did not reclassify, 313 had a second PNB. On second PNB, 120 (38%) had no cancer, 139 (44%) had cancer but no reclassification, and 54 (17%) reclassified. In a multivariable analysis, significant predictors of decreased future reclassification after the first PNB were no cancer on PNB (hazard ratio [HR]=0.50, p=0.008), lower serum prostate-specific antigen, larger prostate size, and lower body mass index. A finding of no cancer on the second PNB was also associated with significantly decreased future reclassification in a multivariable analysis (HR=0.15, p=0.003), regardless of the first PNB result. The major limitation of this study is a relatively small number of patients with long-term follow-up. CONCLUSIONS Men who have a surveillance PNB with no evidence of cancer are significantly less likely to reclassify on AS in the PASS cohort. These findings have implications for tailoring AS protocols. PATIENT SUMMARY Men on active surveillance for prostate cancer who have a biopsy showing no cancer are at a decreased risk of having worse disease in the future. This may have an impact on how frequently biopsies are required to be performed in the future.
Collapse
Affiliation(s)
- James T Kearns
- Department of Urology, University of Washington, Seattle, WA, USA.
| | - Anna V Faino
- Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Lisa F Newcomb
- Department of Urology, University of Washington, Seattle, WA, USA; Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | | | | | - Atreya Dash
- Department of Urology, University of Washington, Seattle, WA, USA
| | - William J Ellis
- Department of Urology, University of Washington, Seattle, WA, USA
| | | | | | | | - Peter S Nelson
- Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Ian M Thompson
- University of Texas Health Sciences Center at San Antonio, TX, USA
| | | | - Yingye Zheng
- Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Daniel W Lin
- Department of Urology, University of Washington, Seattle, WA, USA
| |
Collapse
|
10
|
Özkan TA, Cebeci OÖ, Çevik İ, Dillioğlugil Ö. Prognostic influence of 5 alpha reductase inhibitors in patients with localized prostate cancer under active surveillance. Turk J Urol 2018; 44:132-137. [PMID: 29511582 DOI: 10.5152/tud.2017.39660] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2017] [Accepted: 12/19/2017] [Indexed: 11/22/2022]
Abstract
Objective The incidence of prostate adenocarcinoma (PCa) is increased with the use of prostate-specific antigen (PSA). In the current study, we aimed to investigate the impact of 5- alpha- reductase inhibitors (5-ARI) on pathological progression in patients followed by active surveillance (AS). Material and methods Records of 69 patients with localized prostate cancer under AS (PSA ≤15 ng/mL, PSAD ≤0.20, ≤cT2c, Gleason sum ≤3+3, the number of cancer positive cores ≤3) were evaluated retrospectively. Patients were followed-up with quarterly PSA testing and semiannual digital rectal examination during the first 2 years, and semiannual PSA testing thereafter. Repeat biopsies were done annually and whenever indicated by clinical findings. Pathological progression was defined as increasing Gleason grade, number of cancer-positive cores, and/or increasing percentage of cancer in any core. Results Patients using (29/69: 42%) and not using (40/69: 58%) 5-ARI were followed for a median of 39 (IQR: 23-45) and 23.5 (IQR: 17-37.5) months, respectively. Pathological progression was observed in 32% (22/69) of the patients at a median of 25 (IQR: 18-39) months. Pathological progression was observed in 34.5% (10/29) and 30% (12/40) of the patients using and not using 5-ARI, respectively (Log-rank p=0.4151). Definitive treatment was done in 31% (9/29) and 47.5% (19/40) of the patients using and not using 5-ARI, respectively. Patients who did not use 5-ARI received definitive treatment earlier than 5-ARI users (Log-rank p=0.0342). On multivariate analysis, more than 2 cancer-positive cores (HR: 11.62) and age (HR: 0.94) were independently associated with pathological progression (p<0.05), rather than 5-ARI use (p=0.148). Conclusion More than 2 cancer- positive cores at the initial biopsy was the strongest covariate associated with pathological progression; these patients should not be offered AS. There was no impact of 5-ARI use on pathological progression in AS.
Collapse
Affiliation(s)
- Tayyar Alp Özkan
- Department of Urology, Health of Sciences University, Kocaeli Derince Training and Research Hospital, Kocaeli, Turkey
| | - Oğuz Özden Cebeci
- Department of Urology, Health of Sciences University, Kocaeli Derince Training and Research Hospital, Kocaeli, Turkey
| | - İbrahim Çevik
- Department of Urology, Okan University, School of Medicine, İstanbul, Turkey
| | - Özdal Dillioğlugil
- Department of Urology, Kocaeli University School of Medicine, Kocaeli, Turkey
| |
Collapse
|
11
|
Elfatairy KK, Filson CP, Sanda MG, Osunkoya AO, Geller RL, Nour SG. In-bore MRI-guided biopsy: can it optimize the need for periodic biopsies in prostate cancer patients undergoing active surveillance? A pilot test-retest reliability study. Br J Radiol 2018; 91:20170603. [PMID: 29308912 DOI: 10.1259/bjr.20170603] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE To evaluate the test-retest reliability of repeated in-bore MRI-guided prostate biopsy (MRGB). METHODS 19 lesions in 7 patients who had consecutive MRGBs were retrospectively analysed. Five patients had 2 consecutive MRGBs and two patients had 3 consecutive MRGBs. Both multiparametric MRI and MRGBs were performed using a 3T MRI scanner. Pathology results were categorized into benign, suspicious and malignant. Consistency between first and subsequent biopsy results were analysed as well as the negative predictive value (NPV) for prostate cancer. RESULTS 15 lesions (≈79%) had matching second biopsy and 4 (21%) had non-matching second biopsy. Lesions with both Prostate Imaging - Reporting and Data System(PIRADS) categories 1 and 4 were all benign and had matching pathology results. Lesions with non-matching results had PIRADS categories 2, 3 and 5. NPV for prostate cancer in first biopsy was 87.5%. Overall agreement was 78.9% and overall disagreement was 21.1%.κ = 0.55 denoting moderate agreement (p = 0.002). 10/19 lesions had a third biopsy session. 9/10 (90%) had matching pathology results across the three biopsy sessions and all matching lesions were benign. CONCLUSION In-bore MRI-guided prostate biopsy may have a better reliability for repeat biopsies compared to TRUS biopsy. Final conclusion awaits a prospective analysis on a larger cohort of patients. Advances in knowledge: This pilot study showed that repeated prostate in-bore MRI-guided prostate biopsy may have better reliability compared to TRUS biopsy with a suggested high NPV.
Collapse
Affiliation(s)
- Kareem K Elfatairy
- 1 Department of Radiology and Imaging Sciences, Emory University School of Medicine , Atlanta, GA , United States.,2 Interventional MRI Program,Department of Radiology and Imaging Sciences, Emory University School of Medicine , Atlanta, GA , United States.,3 Department of Radiology, Faculty of Medicine, Suez Canal University , Ismailia , Egypt
| | - Christopher P Filson
- 4 Department of Urology, Emory University School of Medicine , Atlanta, GA , United States.,5 Department of Urology, Veterans Affairs Medical Center , Atlanta, GA , United States.,6 Winship Cancer Institute, Emory University , Atlanta, GA , United States
| | - Martin G Sanda
- 4 Department of Urology, Emory University School of Medicine , Atlanta, GA , United States.,5 Department of Urology, Veterans Affairs Medical Center , Atlanta, GA , United States.,6 Winship Cancer Institute, Emory University , Atlanta, GA , United States
| | - Adeboye O Osunkoya
- 4 Department of Urology, Emory University School of Medicine , Atlanta, GA , United States.,6 Winship Cancer Institute, Emory University , Atlanta, GA , United States.,7 Department of Pathology, Emory University School of Medicine , Atlanta, GA United States.,8 Department of Pathology, Veterans Affairs Medical Center , Atlanta, GA , United States
| | - Rachel L Geller
- 7 Department of Pathology, Emory University School of Medicine , Atlanta, GA United States
| | - Sherif G Nour
- 1 Department of Radiology and Imaging Sciences, Emory University School of Medicine , Atlanta, GA , United States.,2 Interventional MRI Program,Department of Radiology and Imaging Sciences, Emory University School of Medicine , Atlanta, GA , United States.,6 Winship Cancer Institute, Emory University , Atlanta, GA , United States
| |
Collapse
|
12
|
Albkri A, Girier D, Mestre A, Costa P, Droupy S, Chevrot A. Urinary Incontinence, Patient Satisfaction, and Decisional Regret after Prostate Cancer Treatment: A French National Study. Urol Int 2017; 100:50-56. [PMID: 29258084 DOI: 10.1159/000484616] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2017] [Accepted: 10/26/2017] [Indexed: 12/18/2022]
Abstract
BACKGROUND Complications of prostate cancer treatments have a substantial impact on the patient's quality of life. We evaluated the prevalence of urinary consequences and factors affecting patient satisfaction and decisional regret after treatment. METHODS A retrospective self-administered questionnaire was sent to all members of the National Association of Prostate Cancer Patients in France. RESULTS From the 226 completed questionnaires received, the following information was obtained: 110 patients underwent surgery only, 29 received radiotherapy plus hormone therapy, 28 received radiotherapy only, and 49 received other combination treatments. The median follow-up period was 58.1 months. After treatment, the presence of urinary incontinence was reported by 34.5% of patients treated by radical prostatectomy, by 10.3% treated by radiotherapy plus hormone therapy, by 17.8% treated by curitherapy or radiotherapy only, and by 38.7% treated by other combination therapy (p = 0.01). The main reasons for decisional regret were the fact that patients received incomplete information about prostate cancer (40%) and consequences of treatment that affected the urinary system (34%). The information received about cancer was considered complete in 32.3% of the satisfied group and 14.3% of the decisional regret group (p = 0.003) and with regard to urinary incontinence the information received was considered complete in 41.4 and 17.4% respectively (p < 0.01). CONCLUSIONS Urinary consequences of prostate cancer treatment are common and impact the quality of life. Patients need clear information to be able to participate in therapeutic decision-making and to avoid subsequent decisional regret.
Collapse
|
13
|
Preventing clinical progression and need for treatment in patients on active surveillance for prostate cancer. Curr Opin Urol 2017; 28:46-54. [PMID: 29028765 DOI: 10.1097/mou.0000000000000455] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
PURPOSE OF REVIEW Active surveillance is an established treatment option for men with localized, low-risk prostate cancer (CaP). It entails the postponement of immediate therapy with the option of delayed intervention upon disease progression. The rate of clinical progression and need for treatment on active surveillance is approximately 50% over 15 years. The present review summarizes recent data on current methods, attempting to prevent clinical progression. RECENT FINDINGS Patient selection for active surveillance is the first mandatory step required to lower progression. Adherence to active surveillance protocols is critical in making sure patients are monitored well and treated early when progression occurs. Before active surveillance allocation and during active surveillance follow-up, methods involving multiparametric MRI, prostate specific antigen derivatives, biopsy factors, urinary, tissue and genetic markers can be used to prevent clinical progression and/or identify those at risk for progression. Medications such as 5α-reductase inhibitors and others might inhibit disease progression in patients on active surveillance. SUMMARY Active surveillance is required because of overdiagnosis, along with our inability to accurately predict individual CaP behavior. Several methods can potentially reduce the risk of CaP progression in patients with active surveillance. However, a measure of uncertainty and fear of progression will always accompany patients with active surveillance and the physicians treating them.
Collapse
|
14
|
Olvera-Posada D, Welk B, McClure JA, Winick-Ng J, Izawa JI, Pautler SE. The Impact of Multiple Prostate Biopsies on Risk for Major Complications Following Radical Prostatectomy: A Population-based Cohort Study. Urology 2017; 106:125-132. [DOI: 10.1016/j.urology.2017.03.048] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2017] [Revised: 02/23/2017] [Accepted: 03/08/2017] [Indexed: 10/19/2022]
|
15
|
Cabarrus MC, Westphalen AC. Multiparametric magnetic resonance imaging of the prostate-a basic tutorial. Transl Androl Urol 2017; 6:376-386. [PMID: 28725579 PMCID: PMC5503950 DOI: 10.21037/tau.2017.01.06] [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] [Indexed: 12/24/2022] Open
Abstract
Prostate cancer is the second most common cause of cancer related death in the United States and the most commonly diagnosed malignancy in men. In general, prostate cancer is slow growing, though there is a broad spectrum of disease that may be indolent, or aggressive and rapidly progressive. Screening for prostate is controversial and complicated by lack of specificity and over diagnosis of clinically insignificant cancer. Imaging has played a role in diagnosis of prostate cancer, primarily through systemic transrectal ultrasound (TRUS) guided biopsy. While TRUS guided biopsy radically changed prostate cancer diagnosis, it still remains limited by low resolution, poor tissue characterization, relatively low sensitivity and positive predictive value. Advances in multiparametric magnetic resonance imaging (mpMRI) have allowed more accurate detection, localization, and staging as well as aiding in the role of active surveillance (AS). The use of mpMRI for the evaluation of prostate cancer has increased dramatically and this trend is likely to continue as the technique is rapidly improving and its applications expand. The purpose of this article is to review the basic principles of mpMRI of the prostate and its clinical applications, which will be reviewed in greater detail in subsequent chapters of this issue.
Collapse
Affiliation(s)
- Miguel C Cabarrus
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, CA, USA
| | - Antonio C Westphalen
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, CA, USA.,Department of Urology, University of California, San Francisco, San Francisco, CA, USA
| |
Collapse
|
16
|
Reinhold T, Dornquast C, Börgermann C, Weißbach L. [Treatment costs of localized prostate cancer in Germany : Economic results from the HAROW observational study]. Urologe A 2017; 55:1573-1585. [PMID: 27822603 DOI: 10.1007/s00120-016-0258-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND Prostate cancer (PCa) is the most common cancer in men. For medical treatment of PCa, a number of therapies are available. The economic consequences associated with these individual treatment options in routine care in Germany are unclear so far. METHODS The present analysis was based on the Germany-wide HAROW observational study, which was conducted from 2008-2013. During this study, all participating physicians and involved patients reported and documented individual health care resource consumption. These data were evaluated in monetary terms stratified by treatment regime (hormone therapy, HT; active surveillance, AS; radiotherapy, RT; radical prostatectomy, RP; watchful waiting, WW). RESULTS Overall, the data of 2672 patients were available for analysis. Based on the observational study design, the included patient groups were heterogeneous in their baseline characteristics. The annual total costs from the societal perspective were the largest for patient undergoing RP (9254 €; 95 % CI 8353-10,154), mainly driven by the costs for the initial hospital stay for surgery. HT, AS, RT, and WW seem to be comparable in terms of direct costs, ranging from 805 € (95 % CI 154-1455) for WW up to 1115 € (95 % CI 826-1405) for RT. The highest indirect costs were observed for patients receiving RT (3928 €; 95 % CI 0-10,675), which can be justified by the frequent incapacity to work in this patient group. CONCLUSION The treatment of prostate cancer can lead to significant economic follow-up costs which vary greatly depending on the type of treatment. The analysis indicates a need for the implementation of a long-term health economic study in the future, which will be more suitable to show treatment-specific differences in the temporal occurrence of costs.
Collapse
Affiliation(s)
- T Reinhold
- Institut für Sozialmedizin, Epidemiologie und Gesundheitsökonomie, Charite - Universitätsmedizin, Luisenstr. 57, 10117, Berlin, Deutschland.
| | - C Dornquast
- Institut für Sozialmedizin, Epidemiologie und Gesundheitsökonomie, Charite - Universitätsmedizin, Luisenstr. 57, 10117, Berlin, Deutschland
| | - C Börgermann
- Klinik für Urologie, onkologische Urologie und Kinderurologie, Krankenhaus Düren gem. GmbH, Düren, Deutschland
| | - L Weißbach
- Stiftung Männergesundheit, Berlin, Deutschland
| |
Collapse
|
17
|
Murray NP, Reyes E, Fuentealba C, Aedo S, Jacob O. The presence of primary circulating prostate cells is associated with upgrading and upstaging in patients eligible for active surveillance. Ecancermedicalscience 2017; 11:711. [PMID: 28144285 PMCID: PMC5243134 DOI: 10.3332/ecancer.2017.711] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2016] [Indexed: 12/15/2022] Open
Abstract
Active surveillance (AS) is a considered treatment option for men with low or very low-risk prostate cancer. However, on repeat biopsy some 25% were upgraded and recommended for active treatment. We compare the presence or absence of primary circulating prostate cells (CPCs) with the clinical pathological findings after radical prostatectomy in men fulfilling the criteria for active surveillance and the risk of reclassification for active observation (AO).
Collapse
Affiliation(s)
- Nigel P Murray
- Hospital Carabineros of Chile, Nunoa, 7770199 Santiago, Chile; Faculty of Medicine, University Finis Terrae, Providencia, 7501015 Santiago, Chile
| | - Eduardo Reyes
- Faculty of Medicine, University Diego Portales, Manuel Rodrıguez Sur 415, 8370179 Santiago, Chile; Hospital DIPRECA, La Reina, Santiago, Chile
| | | | - Socrates Aedo
- Faculty of Medicine, University Finis Terrae, Providencia, 7501015 Santiago, Chile
| | - Omar Jacob
- Hospital Carabineros of Chile, Nunoa, 7770199 Santiago, Chile
| |
Collapse
|
18
|
Flood TA, Schieda N, Keefe DT, Breau RH, Morash C, Hogan K, Belanger EC, Mai KT, Robertson SJ. Utility of Gleason pattern 4 morphologies detected on transrectal ultrasound (TRUS)-guided biopsies for prediction of upgrading or upstaging in Gleason score 3 + 4 = 7 prostate cancer. Virchows Arch 2016; 469:313-9. [PMID: 27394432 DOI: 10.1007/s00428-016-1981-2] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2016] [Revised: 05/16/2016] [Accepted: 06/27/2016] [Indexed: 01/22/2023]
Abstract
Selected patients with Gleason score (GS) 3 + 4 = 7 prostate cancer (PCa) detected on transrectal ultrasound (TRUS)-guided biopsies may be considered for active surveillance (AS); however, a proportion of these will harbor more aggressive disease. The purpose of this study was to determine if morphologies of Gleason pattern 4 PCa may predict upgrading and/or upstaging after radical prostatectomy (RP). A database search for men with GS 3 + 4 = 7 PCa diagnosed on TRUS-guided biopsy that underwent RP between January 2010 and October 2015 identified 152 patients. Two blinded genitourinary pathologists independently reviewed the biopsies and assessed ill-defined glands (IDG), fused glands, small or large cribriform patterns, and glomerulations. Patient age, serum prostate-specific antigen (PSA), percentage (%) of biopsy sites involved by 3 + 4 = 7 PCa, and overall extent of pattern 4 were also recorded. GS and stage (presence or absence of extraprostatic extension [EPE]) were retrieved from RP reports. Data were compared using independent t tests and chi-square. Inter-observer agreement was calculated using Cohen's Kappa statistic. Percent of biopsy sites and extent of pattern 4 were compared to statistically significant morphologies using the Spearman correlation. 28.3 % (43/152) of patients were upgraded to GS >3 + 4 = 7 at RP (GS 4 + 3 = 7 [N = 17], GS 4 + 3 = 7 with tertiary pattern 5 [N = 25], and GS 4 + 5 = 9 [N = 1]) and 44.1 % (67/152) showed EPE after RP. PSA was associated with both upgrading (8.5 ± 5.4 vs. 6.9 ± 3.2 ng/mL, [p = 0.04]) and EPE (8.2 ± 4.6 vs. 6.7 ± 3.2 ng/mL, [p = 0.03]). IDG, fused glands, and glomerulations were not associated with upgrading or EPE (p > 0.05) with moderate to strong inter-observer agreement (K = 0.76-0.88). There was strong inter-observer agreement for small and large cribriform formations (K = 0.93 and 0.94, respectively) and both patterns were strongly associated with upgrading (p < 0.001) and EPE (p = 0.02) on RP. Strong associations were observed between increasing number of morphologies and both upgrading (p = 0.0.25) and EPE (p < 0.001). Overall extent of pattern 4 was associated with upgrading (p = 0.009) and EPE (p = 0.019) while percent of sites involved by GS 3 + 4 = 7 was only associated with EPE (p = 0.023). Cribriform morphology correlated to percentage of sites with 3 + 4 and overall extent of pattern 4 (rho = 0.25, p = 0.002, rho = 0.20, p = 0.015, respectively). Presence of cribriform morphology on TRUS-guided biopsy is strongly associated with upgrading and upstaging at RP and shows near-perfect inter-observer agreement whereas IDG, fused glands, and glomerulations were not useful. Cribriform morphology may be of importance when considering treatment plans for patients with intermediate risk PCa.
Collapse
Affiliation(s)
- Trevor A Flood
- Department of Pathology and Laboratory Medicine, Faculty of Medicine, The Ottawa Hospital, The University of Ottawa, 501 Smyth Road, 4th Floor CCW, Ottawa, Ontario, K1H 8L6, Canada.
| | - Nicola Schieda
- Department of Pathology and Laboratory Medicine, Faculty of Medicine, The Ottawa Hospital, The University of Ottawa, 501 Smyth Road, 4th Floor CCW, Ottawa, Ontario, K1H 8L6, Canada.,Department of Medical Imaging, The Ottawa Hospital, Ottawa, Canada
| | - Daniel T Keefe
- Department of Pathology and Laboratory Medicine, Faculty of Medicine, The Ottawa Hospital, The University of Ottawa, 501 Smyth Road, 4th Floor CCW, Ottawa, Ontario, K1H 8L6, Canada.,Department of Urology, The Ottawa Hospital, Ottawa, Canada
| | - Rodney H Breau
- Department of Pathology and Laboratory Medicine, Faculty of Medicine, The Ottawa Hospital, The University of Ottawa, 501 Smyth Road, 4th Floor CCW, Ottawa, Ontario, K1H 8L6, Canada.,Department of Urology, The Ottawa Hospital, Ottawa, Canada
| | - Chris Morash
- Department of Pathology and Laboratory Medicine, Faculty of Medicine, The Ottawa Hospital, The University of Ottawa, 501 Smyth Road, 4th Floor CCW, Ottawa, Ontario, K1H 8L6, Canada.,Department of Urology, The Ottawa Hospital, Ottawa, Canada
| | - Kevin Hogan
- Department of Pathology and Laboratory Medicine, Faculty of Medicine, The Ottawa Hospital, The University of Ottawa, 501 Smyth Road, 4th Floor CCW, Ottawa, Ontario, K1H 8L6, Canada
| | - Eric C Belanger
- Department of Pathology and Laboratory Medicine, Faculty of Medicine, The Ottawa Hospital, The University of Ottawa, 501 Smyth Road, 4th Floor CCW, Ottawa, Ontario, K1H 8L6, Canada
| | - Kien T Mai
- Department of Pathology and Laboratory Medicine, Faculty of Medicine, The Ottawa Hospital, The University of Ottawa, 501 Smyth Road, 4th Floor CCW, Ottawa, Ontario, K1H 8L6, Canada
| | - Susan J Robertson
- Department of Pathology and Laboratory Medicine, Faculty of Medicine, The Ottawa Hospital, The University of Ottawa, 501 Smyth Road, 4th Floor CCW, Ottawa, Ontario, K1H 8L6, Canada
| |
Collapse
|
19
|
Ueno Y, Tamada T, Bist V, Reinhold C, Miyake H, Tanaka U, Kitajima K, Sugimura K, Takahashi S. Multiparametric magnetic resonance imaging: Current role in prostate cancer management. Int J Urol 2016; 23:550-7. [PMID: 27184019 DOI: 10.1111/iju.13119] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2016] [Accepted: 04/07/2016] [Indexed: 12/31/2022]
Abstract
Digital rectal examination, serum prostate-specific antigen screening and transrectal ultrasound-guided biopsy are conventionally used as screening, diagnostic and surveillance tools for prostate cancer. However, they have limited sensitivity and specificity. In recent years, the role of multiparametric magnetic resonance imaging has steadily grown, and is now part of the standard clinical management in many institutions. In multiparametric magnetic resonance imaging, the morphological assessment of T2-weighted imaging is correlated with diffusion-weighted imaging, dynamic contrast-enhanced imaging perfusion and/or magnetic resonance spectroscopic imaging. Multiparametric magnetic resonance imaging is currently regarded as the most sensitive and specific imaging technique for the evaluation of prostate cancer, including detection, staging, localization and aggressiveness evaluation. This article presents an overview of multiparametric magnetic resonance imaging, and discusses the current role of multiparametric magnetic resonance imaging in the different fields of prostate cancer management.
Collapse
Affiliation(s)
- Yoshiko Ueno
- Department of Radiology, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan.,Department of Radiology, McGill University Health Center, Montreal, Quebec, Canada
| | - Tsutomu Tamada
- Department of Radiology, Kawasaki Medical School, Kurashiki, Okayama, Japan
| | - Vipul Bist
- Department of Radiology, McGill University Health Center, Montreal, Quebec, Canada
| | - Caroline Reinhold
- Department of Radiology, McGill University Health Center, Montreal, Quebec, Canada
| | - Hideaki Miyake
- Department of Urology, Hamamatsu University School of Medicine, Hamamatsu, Shizuoka, Japan
| | - Utaru Tanaka
- Department of Radiology, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan
| | - Kazuhiro Kitajima
- Department of Radiology, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan.,Department of Nuclear Medicine and PET Center, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan
| | - Kazuro Sugimura
- Department of Radiology, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan
| | - Satoru Takahashi
- Department of Radiology, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan
| |
Collapse
|
20
|
Abstract
A major dilemma in the selection of treatment for men with prostate cancer is the difficulty in accurately characterizing the risk posed by the cancer. This uncertainty has led physicians to recommend aggressive therapy for most men diagnosed with prostate cancer and has led to concerns about the benefits of screening and the adverse consequences of excessive treatment. Genomic analyses of prostate cancer reveal distinct patterns of alterations in the genomic landscape of the disease that show promise for improved prediction of prognosis and better medical decision making. Several molecular profiles are now commercially available and are being used to inform medical decisions. This article describes the clinical tests available for distinguishing aggressive from nonaggressive prostate cancer, reviews the new genomic tests, and discusses their advantages and limitations and the evidence for their utility in various clinical settings.
Collapse
Affiliation(s)
- Itay A Sternberg
- Department of Urology, Meir Medical Center, Kefar Sava, 4428164, Israel;
| | - Ian Vela
- Department of Urology, Princess Alexandra Hospital and Australian Prostate Cancer Research Center, Queensland University of Technology, Brisbane, Queensland, Australia;
| | - Peter T Scardino
- Department of Surgery and the Sidney Kimmel Center for Prostate and Urologic Cancers, Memorial Sloan Kettering Cancer Center, New York, New York 10065;
| |
Collapse
|
21
|
Reichard CA, Stephenson AJ, Klein EA. Applying precision medicine to the active surveillance of prostate cancer. Cancer 2015; 121:3403-11. [PMID: 26149066 PMCID: PMC4758404 DOI: 10.1002/cncr.29496] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2015] [Revised: 04/29/2015] [Accepted: 05/04/2015] [Indexed: 01/05/2023]
Abstract
The recent introduction of a variety of molecular tests will potentially reshape the care of patients with prostate cancer. These tests may make more accurate management decisions possible for those patients who have been "overdiagnosed" with biologically indolent disease, which represents an exceptionally small mortality risk. There is a wide range of possible applications of these tests to different clinical scenarios in patient populations managed with active surveillance. Cancer 2015;121:3435-43. © 2015 American Cancer Society.
Collapse
Affiliation(s)
- Chad A. Reichard
- Glickman Urological and Kidney InstituteCleveland ClinicClevelandOhio
| | | | - Eric A. Klein
- Glickman Urological and Kidney InstituteCleveland ClinicClevelandOhio
| |
Collapse
|
22
|
Herden J, Wille S, Weissbach L. Active surveillance in localized prostate cancer: comparison of incidental tumours (T1a/b) and tumours diagnosed by core needle biopsy (T1c/T2a): results from the HAROW study. BJU Int 2015; 118:258-63. [PMID: 26332209 DOI: 10.1111/bju.13308] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To conduct a comparative prospective analysis of patients with incidental T1a/T1b prostate cancer (IPCa) and those with prostate cancer (PCa) diagnosed by core needle biopsy, treated by active surveillance (AS), with regard to inclusion criteria, progression and switch to deferred treatment. PATIENTS AND METHODS The HAROW study is an observational outcomes research study on the management of localized PCa. Treating urologists reported clinical variables and information on therapy and clinical course of disease at 6-month intervals. With respect to therapy, only recommendations were made; the final decision on the therapeutic method rested with the treating physician. RESULTS Out of 2 957 patients included in the HAROW study, 447 chose AS. The median follow-up was 28.3 months. T1a, T1b, T1c and T2a disease were diagnosed in 81, 18, 292 and 56 patients, respectively. Patients in the IPCa group had lower prostate-specific antigen (PSA) levels (4.2 vs 6.1 ng/mL) and more comorbidities than those diagnosed by core needle biospy. The IPCa group also had fewer re-biopsies (25.3 vs 43.2%) and fewer changes to invasive treatment (12.1 vs 25.9%). No significant differences were found with respect to the criteria for discontinuation, subsequent therapies and histological findings after radical prostatectomy. CONCLUSION Urologists are highly inclined to use AS as a therapeutic option in IPCa. More patients with IPCa than those diagnosed after core needle biopsy continued on AS, which was also associated with the indication for a re-biopsy being less stringently observed.
Collapse
Affiliation(s)
- Jan Herden
- Department of Urology, University Hospital Cologne, Cologne, Germany
| | - Sebastian Wille
- Department of Urology, University Hospital Cologne, Cologne, Germany
| | | |
Collapse
|
23
|
Image-based monitoring of targeted biopsy-proven prostate cancer on active surveillance: 11-year experience. World J Urol 2015; 34:221-7. [PMID: 26093647 DOI: 10.1007/s00345-015-1619-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2015] [Accepted: 06/10/2015] [Indexed: 10/23/2022] Open
Abstract
PURPOSE To report our 11-year experience of Active Surveillance (AS) program focusing on modern transrectal ultrasound (TRUS)-based monitoring of targeted biopsy-proven cancer lesion. METHODS Consecutive patients on AS, who had targeted biopsy-proven lesion followed by at least a repeat surveillance biopsy and three times TRUS monitoring of the identical visible lesion, were included. Doppler grade of blood flow signal within the lesion was classified from grade 0 to 3. Biopsy-proven progression was defined as upgrade of Gleason score or 25% or greater increase in cancer core involvement. RESULTS Fifty patients were included in this study. Clinical variables (median) included age (61 years), clinical stage (T1c, 42;T2, 8), PSA (4.6 ng/ml), and Gleason score (3 + 3, n = 41;3 + 4, n = 9). Of the 50 patients, 34 demonstrated pathological progression at a median follow-up of 4.4 years. In comparing between without (n = 16) and with (n = 34) pathological progression, there were significant differences in cancer core involvement at entry (p = 0.003), the major axis diameter (p = 0.001) and minor axis diameter (p = 0.001) of the visible lesion at entry, increase in the major axis diameter (p = 0.005) and minor axis diameter (p = 0.013), and upgrade of Doppler grade (p < 0.0001). In multivariate analysis for predicting pathological progression, the increase (≥25%) in diameter of biopsy-proven lesion (hazard ratio, 15.314; p = 0.023) and upgrade of Doppler grade (hazard ratio, 37.409; p = 0.019) were significant risk factors. CONCLUSIONS Longitudinal monitoring of the TRUS-visible biopsy-proven cancer provides a new opportunity to perform per-lesion-based AS. The increase in diameter and upgrade of Doppler grade of the lesion were significant risk factors for biopsy-proven progression on AS.
Collapse
|
24
|
Loeb S, Bruinsma SM, Nicholson J, Briganti A, Pickles T, Kakehi Y, Carlsson SV, Roobol MJ. Active surveillance for prostate cancer: a systematic review of clinicopathologic variables and biomarkers for risk stratification. Eur Urol 2014; 67:619-26. [PMID: 25457014 DOI: 10.1016/j.eururo.2014.10.010] [Citation(s) in RCA: 113] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2014] [Accepted: 10/03/2014] [Indexed: 11/29/2022]
Abstract
CONTEXT Active surveillance (AS) is an important strategy to reduce prostate cancer overtreatment. However, the optimal criteria for eligibility and predictors of progression while on AS are debated. OBJECTIVE To review primary data on markers, genetic factors, and risk stratification for patient selection and predictors of progression during AS. EVIDENCE ACQUISITION Electronic searches were conducted in PubMed, Embase, and the Cochrane Central Register of Controlled Trials (CENTRAL) from inception to April 2014 for original articles on biomarkers and risk stratification for AS. EVIDENCE SYNTHESIS Patient factors associated with AS outcomes in some studies include age, race, and family history. Multiple studies provide consistent evidence that a lower percentage of free prostate-specific antigen (PSA), a higher Prostate Health Index (PHI), a higher PSA density (PSAD), and greater biopsy core involvement at baseline predict a greater risk of progression. During follow-up, serial measurements of PHI and PSAD, as well as repeat biopsy results, predict later biopsy progression. While some studies have suggested a univariate relationship between urinary prostate cancer antigen 3 (PCA3) and transmembrane protease, serine 2-v-ets avian erythroblastosis virus E26 oncogene homolog gene fusion (TMPRSS2:ERG) with adverse biopsy features, these markers have not been consistently shown to independently predict AS outcomes. No conclusive data support the use of genetic tests in AS. Limitations of these studies include heterogeneous definitions of progression and limited follow-up. CONCLUSIONS There is a growing body of literature on patient characteristics, biopsy features, and biomarkers with potential utility in AS. More data are needed on practical applications such as combining these tests into multivariable clinical algorithms and long-term outcomes to further improve AS in the future. PATIENT SUMMARY Several PSA-based tests (free PSA, PHI, PSAD) and the extent of cancer on biopsy can help to stratify the risk of progression during active surveillance. Investigation of several other markers is under way.
Collapse
Affiliation(s)
- Stacy Loeb
- Department of Urology, New York University and the Manhattan Veterans Affairs Hospital, New York, NY, USA
| | - Sophie M Bruinsma
- Department of Urology, Erasmus Medical Centre, Rotterdam, The Netherlands
| | | | - Alberto Briganti
- Division of Oncology, Unit of Urology, Urological Research Institute, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Tom Pickles
- BC Cancer Agency Radiation Therapy Program, BC Cancer Agency, Vancouver Centre, Vancouver, Canada; University of British Columbia, Vancouver, BC, Canada
| | - Yoshiyuki Kakehi
- Department of Urology, Faculty of Medicine, Kagawa University, Miki-cho, Kita-gun, Kagawa, Japan
| | - Sigrid V Carlsson
- Department of Urology, Institute of Clinical Sciences, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden; Department of Surgery (Urology Service), Memorial Sloan-Kettering Cancer Center, New York, NY, USA
| | - Monique J Roobol
- Department of Urology, Erasmus Medical Centre, Rotterdam, The Netherlands.
| |
Collapse
|
25
|
Kanao K, Komori O, Nakashima J, Ohigashi T, Kikuchi E, Miyajima A, Nakagawa K, Eguchi S, Oya M. Individualized prostate-specific antigen threshold values to avoid overdiagnosis of prostate cancer and reduce unnecessary biopsy in elderly men. Jpn J Clin Oncol 2014; 44:852-9. [PMID: 25030213 DOI: 10.1093/jjco/hyu084] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVE To individualize prostate-specific antigen threshold values to avoid overdiagnosis of prostate cancer and reduce unnecessary biopsy in elderly men. METHODS A total of 406 men aged over 70 years old with prostate-specific antigen levels between 4.0 and 20.0 ng/ml, normal digital rectal examination results and diagnosed by transrectal needle biopsy were retrospectively analyzed. The patients were divided into a no/favorable-risk cancer group or an unfavorable-risk cancer group based on their Gleason score and the number of positive cores. Prostate-specific antigen levels, percent free prostate-specific antigen level, prostate transition zone volume and the number of previous biopsies were used to discriminate between the two groups. The optimal individualized prostate-specific antigen threshold values based on the other variables that gave a sensitivity of 95% for the detection of unfavorable-risk cancer were calculated using a boosting method for maximizing the area under the receiver operating characteristic curve. RESULTS A total of 66 men had favorable-risk cancer, and 139 had unfavorable-risk cancer. The area under the receiver operating characteristic curve of the combination model determined by the boosting method for maximizing the area under the receiver operating characteristic curve was 0.852. The sensitivity and specificity of the threshold values for the detection of unfavorable-risk cancer were 95 and 36%, respectively. By using the threshold values, 100 (25%) of the subjects with no/favorable-risk cancer could have avoided undergoing biopsies, with a <5% risk of missing the detection of unfavorable-risk cancer. CONCLUSIONS These individualized prostate-specific antigen threshold values may be useful for determining an indication of prostate biopsy for elderly men to avoid overdiagnosis of prostate cancer and reduce unnecessary biopsy.
Collapse
Affiliation(s)
- Kent Kanao
- Department of Urology, Aichi Medical University, Nagakute
| | | | - Jun Nakashima
- Department of Urology, Tokyo Medical University, Tokyo
| | - Takashi Ohigashi
- Department of Urology, International University of Health and Welfare Mita Hospital, Tokyo and
| | - Eiji Kikuchi
- Department of Urology, Keio University School of Medicine, Tokyo, Japan
| | - Akira Miyajima
- Department of Urology, Keio University School of Medicine, Tokyo, Japan
| | - Ken Nakagawa
- Department of Urology, Keio University School of Medicine, Tokyo, Japan
| | | | - Mototsugu Oya
- Department of Urology, Keio University School of Medicine, Tokyo, Japan
| |
Collapse
|
26
|
Azmi A, Dillon RA, Borghesi S, Dunne M, Power RE, Marignol L, O'Neill BDP. Active surveillance for low-risk prostate cancer: diversity of practice across Europe. Ir J Med Sci 2014; 184:305-11. [PMID: 24652265 DOI: 10.1007/s11845-014-1104-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2013] [Accepted: 03/03/2014] [Indexed: 12/29/2022]
Abstract
BACKGROUND Active surveillance (AS) is a recognised treatment option for low-risk prostate cancer (PCa). AIMS To review AS criteria in terms of patient selection, follow-up and indications for intervention. METHODS A total of 2,959 potential participants were identified and invited via email to complete an online survey. Only urologists practising in an EU country were eligible to participate. Statistical analyses were carried out using SPSS version 18.0. The χ (2) test was used to compare responses between those who do and do not follow an AS protocol. RESULTS Response rate was 8% (n = 226). Ninety-seven per cent urologists offer AS; 25% (n = 53/215) within a clinical trial and a further 28% (n = 60/215) using an official AS protocol. Gleason score ≤ 3 + 3 = 6 (87 %, n = 173/200) and prostate-specific antigen (PSA) ≤ 10 ng/ml (86%, n = 170/198) are the commonest selection criteria. There was a statistically significant association between having an AS protocol and using PSA as an eligibility criterion (p = 0.03). For urologists not following a protocol, 11% do not consider PSA as an eligibility criterion and 81% consider PSA ≤ 10 ng/ml to decide on AS, compared to 2 and 90%, respectively, who adhere to a protocol. Twenty-four per cent of urologists without a protocol do not re-biopsy in comparison to 11% with a protocol (p = 0.026). Gleason score progression trigger the most intervention (n = 168/192, 87%). CONCLUSIONS Urologists not adhering to an AS protocol or participating in a clinical trial appear to apply less rigorous criteria for both eligibility and monitoring in AS.
Collapse
Affiliation(s)
- A Azmi
- St. Luke's Radiation Oncology Centre, Beaumont Hospital, Dublin, Ireland,
| | | | | | | | | | | | | |
Collapse
|
27
|
Berney DM, Algaba F, Camparo P, Compérat E, Griffiths D, Kristiansen G, Lopez-Beltran A, Montironi R, Varma M, Egevad L. Variation in reporting of cancer extent and benign histology in prostate biopsies among European pathologists. Virchows Arch 2014; 464:583-7. [PMID: 24590584 DOI: 10.1007/s00428-014-1554-1] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2013] [Revised: 01/27/2014] [Accepted: 02/09/2014] [Indexed: 12/17/2022]
Abstract
It is not known how uropathologists currently report histopathological features of prostate biopsies such as core length, tumor extent, perineural invasion, and non-tumor-associated features such as inflammation and hyperplasia in needle biopsies. A web-based survey was distributed among 661 members of the European Network of Uropathology. Complete replies were received from 266 pathologists in 22 European countries. Total core lengths were reported by 64 %. The numbers of cores positive for cancer was given by 79 %. Linear cancer extent was reported by 81 %, most often given in millimeters for each core (53 %) followed by the estimation of percentage of cancer in each core (40 %). A gap of benign tissue between separate cancer foci in a single core would always be subtracted by 48 % and by 63 % if cancer foci were minute and widely separated. Perineural invasion was reported by 97 %. Fat invasion by tumor was interpreted as extraprostatic extension by 81 %. Chronic and active/acute inflammation was always reported by 32 and 56 % but only if pronounced by 54 and 39 %, respectively. While most (79 %) would never diagnose benign prostatic hyperplasia on needle biopsy, 21 % would attempt to make this diagnosis. Reporting practices for prostate biopsies are variable among European pathologists. The great variation in some methodologies used suggests a need for further international consensus, in order for retrospective data to be comparable between different institutions.
Collapse
Affiliation(s)
- D M Berney
- Queen Mary, University of London, London, UK,
| | | | | | | | | | | | | | | | | | | |
Collapse
|
28
|
Abstract
OBJECTIVE The purpose of this article is to review the many evolving facets of MRI in the evaluation of prostate cancer. We will discuss the roles of multiparametric MRI, including diffusion-weighted MRI, dynamic contrast-enhanced MRI, and MR spectroscopy, as adjuncts to morphologic T2-weighted imaging in detection, staging, treatment planning, and surveillance of prostate cancer. CONCLUSION Radiologists need to understand the advantages, limitations, and potential pitfalls of the different sequences to provide optimal assessment of prostate cancer.
Collapse
|
29
|
Alonzo DG, Mure AL, Soloway MS. Prostate cancer and the increasing role of active surveillance. Postgrad Med 2013; 125:109-16. [PMID: 24113669 DOI: 10.3810/pgm.2013.09.2705] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Prostate cancer (PC) is the most often diagnosed non-skin cancer and the second leading cause of cancer-related death among men in the United States. As a result, for many years the American Urological Association (AUA) and the American Cancer Society have issued statements recommending screening for PC, resulting in its widespread implementation in the United States. Recently, the United States Preventative Services Task Force gave PC screening a recommendation of D, that is, against PC screening for all men. The AUA countered this recommendation, stating that since the development of PC screening using prostate-specific antigen, a reduction in PC-specific mortality has been seen, and that the risk reduction occurred in a setting in which many of the patients were not aggressively treated for prostate cancer. Active surveillance may be described as a method to potentially delay or obviate the need for treatment in men with clinically insignificant PC or PC thought to be at low risk for progression. Studies have shown no significant difference in outcome or pathology between men with low risk PC who receive treatment at the point of progression and those undergoing immediate treatment. Ongoing studies are evaluating the efficacy and utility of active surveillance for low-risk PC. Interim results of these studies have shown that approximately 30% of patients progress on active surveillance. However, "progression" does not necessarily mean treatment failure; rarely do patients develop locally advanced or metastatic disease. Active surveillance has also been shown to be cost-effective when compared with immediate treatment for PC. Longer follow-up may continue to show an increased benefit of active surveillance as a reasonable initial approach to the management of men with low-risk, clinically localized PC.
Collapse
Affiliation(s)
- David Gabriel Alonzo
- The University of Miami Miller School of Medicine, Department of Urology, Miami, FL
| | | | | |
Collapse
|
30
|
Words of wisdom. Re: Medium-term outcomes of active surveillance for localized prostate cancer. Eur Urol 2013; 64:1013-4. [PMID: 24209447 DOI: 10.1016/j.eururo.2013.09.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
|
31
|
Berney DM, Algaba F, Camparo P, Compérat E, Griffiths D, Kristiansen G, Lopez-Beltran A, Montironi R, Varma M, Egevad L. The reasons behind variation in Gleason grading of prostatic biopsies: areas of agreement and misconception among 266 European pathologists. Histopathology 2013; 64:405-11. [PMID: 24102975 DOI: 10.1111/his.12284] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2013] [Accepted: 09/09/2013] [Indexed: 12/30/2022]
Abstract
AIMS The Gleason scoring system underwent revision at the International Society of Urological Pathology (ISUP) conference in 2005. It is not known how uropathologists have interpreted its recommendations. METHOD AND RESULTS A web-based survey to European Network of Uropathology members received replies from 266 pathologists in 22 countries. Eighty-nine per cent claimed to follow ISUP recommendations. Key areas of disagreement included the following. Smoothly rounded cribriform glands were assigned Gleason pattern (GP) 3 by 51% and GP 4 by 49%. Necrosis was diagnosed as GP 5 by 62%. Any amount of secondary pattern of higher grade in needle biopsies was included in the Gleason score by 58%. Tertiary GP of higher grade on needle biopsies was included in the Gleason score by only 58%. If biopsy cores were embedded separately, only 56% would give a Gleason score for each core/slide examined; 68% would give a concluding Gleason score and the most common method was a global Gleason score (77%). Among those who blocked multiple biopsy cores together, 46% would only give an overall Gleason score for the case. CONCLUSION Misinterpretation of ISUP 2005 is widespread, and may explain the variation in Gleason scoring seen. Clarity and uniformity in teaching ISUP 2005 recommendations is necessary.
Collapse
|
32
|
Klaassen Z, Wyatt B, Moses KA, Terris MK. Words of wisdom. Re: Active surveillance for prostate cancer compared with immediate treatment: an economic analysis. Eur Urol 2013; 64:855. [PMID: 24112612 DOI: 10.1016/j.eururo.2013.08.039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- Zachary Klaassen
- Section of Urology, Department of Surgery, Medical College of Georgia - Georgia Regents University, Augusta, GA, USA
| | | | | | | |
Collapse
|
33
|
Hashine K, Iio H, Ueno Y, Tsukimori S, Ninomiya I. Surveillance biopsy and active treatment during active surveillance for low-risk prostate cancer. Int J Clin Oncol 2013; 19:531-5. [DOI: 10.1007/s10147-013-0584-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2013] [Accepted: 06/02/2013] [Indexed: 11/28/2022]
|
34
|
Carter HB. Active surveillance for prostate cancer: an underutilized opportunity for reducing harm. J Natl Cancer Inst Monogr 2013; 2012:175-83. [PMID: 23271770 DOI: 10.1093/jncimonographs/lgs036] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
The management of localized prostate cancer is controversial, and in the absence of comparative trials to inform best practice, choices are driven by personal beliefs with wide variation in practice patterns. Men with localized disease diagnosed today often undergo treatments that will not improve overall health outcomes, and active surveillance has emerged as one approach to reducing this overtreatment of prostate cancer. The selection of appropriate candidates for active surveillance should balance the risk of harm from prostate cancer without treatment, and a patient's personal preferences for living with a cancer and the potential side effects of curative treatments. Although limitations exist in assessing the potential for a given prostate cancer to cause harm, the most common metrics used today consider cancer stage, prostate biopsy features, and prostate-specific antigen level together with the risk of death from nonprostate causes based on age and overall state of health.
Collapse
Affiliation(s)
- H Ballentine Carter
- Department of Urology, Johns Hopkins Hospital, 600 N. Wolfe St, Baltimore, MD 21287-2101, USA.
| |
Collapse
|
35
|
Ukimura O, de Castro Abreu AL, Gill IS, Shoji S, Hung AJ, Bahn D. Image visibility of cancer to enhance targeting precision and spatial mapping biopsy for focal therapy of prostate cancer. BJU Int 2013; 111:E354-64. [DOI: 10.1111/bju.12124] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Affiliation(s)
- Osamu Ukimura
- Center of Image-Guided Surgery and Hillard and Roclyn Herzog Center for Robotic Surgery; USC Institute of Urology; Keck School of Medicine; University of Southern California; Los Angeles; CA; USA
| | - Andre Luis de Castro Abreu
- Center of Image-Guided Surgery and Hillard and Roclyn Herzog Center for Robotic Surgery; USC Institute of Urology; Keck School of Medicine; University of Southern California; Los Angeles; CA; USA
| | - Inderbir S. Gill
- Center of Image-Guided Surgery and Hillard and Roclyn Herzog Center for Robotic Surgery; USC Institute of Urology; Keck School of Medicine; University of Southern California; Los Angeles; CA; USA
| | - Sunao Shoji
- Center of Image-Guided Surgery and Hillard and Roclyn Herzog Center for Robotic Surgery; USC Institute of Urology; Keck School of Medicine; University of Southern California; Los Angeles; CA; USA
| | - Andrew J. Hung
- Center of Image-Guided Surgery and Hillard and Roclyn Herzog Center for Robotic Surgery; USC Institute of Urology; Keck School of Medicine; University of Southern California; Los Angeles; CA; USA
| | - Duke Bahn
- Center of Image-Guided Surgery and Hillard and Roclyn Herzog Center for Robotic Surgery; USC Institute of Urology; Keck School of Medicine; University of Southern California; Los Angeles; CA; USA
| |
Collapse
|
36
|
Abern MR, Aronson WJ, Terris MK, Kane CJ, Presti JC, Amling CL, Freedland SJ. Delayed radical prostatectomy for intermediate-risk prostate cancer is associated with biochemical recurrence: possible implications for active surveillance from the SEARCH database. Prostate 2013; 73:409-17. [PMID: 22996686 DOI: 10.1002/pros.22582] [Citation(s) in RCA: 67] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2012] [Accepted: 08/16/2012] [Indexed: 11/08/2022]
Abstract
INTRODUCTION Active surveillance (AS) is increasingly accepted as appropriate management for low-risk prostate cancer (PC) patients. It is unknown whether delaying radical prostatectomy (RP) is associated with increased risk of biochemical recurrence (BCR) for men with intermediate-risk PC. METHODS We performed a retrospective analysis of 1,561 low and intermediate-risk men from the Shared Equal Access Regional Cancer Hospital (SEARCH) database treated with RP between 1988 and 2011. Patients were stratified by interval between diagnosis and RP (≤ 3, 3-6, 6-9, or >9 months) and by risk using the D'Amico classification. Cox proportional hazard models were used to analyze BCR. Logistic regression was used to analyze positive surgical margins (PSM), extracapsular extension (ECE), and pathologic upgrading. RESULTS Overall, 813 (52%) men were low-risk, and 748 (48%) intermediate-risk. Median follow-up among men without recurrence was 52.9 months, during which 437 men (38.9%) recurred. For low-risk men, RP delays were unrelated to BCR, ECE, PSM, or upgrading (all P > 0.05). For intermediate-risk men, however, delays >9 months were significantly related to BCR (HR: 2.10, P = 0.01) and PSM (OR: 4.08, P < 0.01). Delays >9 months were associated with BCR in subsets of intermediate-risk men with biopsy Gleason score ≤ 3 + 4 (HR: 2.51, P < 0.01), PSA ≤ 6 (HR: 2.82, P = 0.06), and low tumor volume (HR: 2.59, P = 0.06). CONCLUSIONS For low-risk men, delayed RP did not significantly affect outcome. For men with intermediate-risk disease, delays >9 months predicted greater BCR and PSM risk. If confirmed in future studies, this suggests delayed RP for intermediate-risk PC may compromise outcomes.
Collapse
Affiliation(s)
- Michael R Abern
- Division of Urologic Surgery, Department of Surgery, Duke University School of Medicine, Durham, North Carolina 27705, USA.
| | | | | | | | | | | | | |
Collapse
|
37
|
Evaluation of Diffusion-Weighted MR Imaging at Inclusion in an Active Surveillance Protocol for Low-Risk Prostate Cancer. Invest Radiol 2013; 48:152-7. [DOI: 10.1097/rli.0b013e31827b711e] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
38
|
Godtman RA, Holmberg E, Khatami A, Stranne J, Hugosson J. Outcome Following Active Surveillance of Men with Screen-detected Prostate Cancer. Results from the Göteborg Randomised Population-based Prostate Cancer Screening Trial. Eur Urol 2013; 63:101-7. [DOI: 10.1016/j.eururo.2012.08.066] [Citation(s) in RCA: 106] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2012] [Accepted: 08/28/2012] [Indexed: 10/27/2022]
|
39
|
Linder BJ, Frank I, Umbreit EC, Shimko MS, Fernández N, Rangel LJ, Karnes RJ. Standard and saturation transrectal prostate biopsy techniques are equally accurate among prostate cancer active surveillance candidates. Int J Urol 2012; 20:860-4. [DOI: 10.1111/iju.12061] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2012] [Accepted: 11/25/2012] [Indexed: 11/30/2022]
Affiliation(s)
- Brian J Linder
- Department of Urology; Mayo Clinic; Rochester; Minnesota; USA
| | - Igor Frank
- Department of Urology; Mayo Clinic; Rochester; Minnesota; USA
| | - Eric C Umbreit
- Department of Urology; Mayo Clinic; Rochester; Minnesota; USA
| | - Mark S Shimko
- Department of Urology; Mayo Clinic; Rochester; Minnesota; USA
| | | | - Laureano J Rangel
- Department of Health Sciences Research; Mayo Clinic; Rochester; Minnesota; USA
| | | |
Collapse
|
40
|
Race is associated with discontinuation of active surveillance of low-risk prostate cancer: results from the Duke Prostate Center. Prostate Cancer Prostatic Dis 2012; 16:85-90. [PMID: 23069729 DOI: 10.1038/pcan.2012.38] [Citation(s) in RCA: 59] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
BACKGROUND Active surveillance (AS) is increasingly utilized in low-risk prostate cancer (PC) patients. Although black race has traditionally been associated with adverse PC characteristics, its prognostic value for patients managed with AS is unclear. METHODS A retrospective review identified 145 patients managed with AS at the Duke Prostate Center from January 2005 to September 2011. Race was patient-reported and categorized as black, white or other. Inclusion criteria included PSA <10 ng ml(-1), Gleason sum ≤ 6, and ≤ 33% of cores with cancer on diagnostic biopsy. The primary outcome was discontinuation of AS for treatment due to PC progression. In men who proceeded to treatment after AS, the trigger for treatment, follow-up PSA and biopsy characteristics were analyzed. Time to treatment was analyzed with univariable and multivariable Cox proportional hazards models and also stratified by race. RESULTS In our AS cohort, 105 (72%) were white, 32 (22%) black and 8 (6%) another race. Median follow-up was 23.0 months, during which 23% percent of men proceeded to treatment. The demographic, clinical and follow-up characteristics did not differ by race. There was a trend toward more uninsured black men (15.6% black, 3.8% white, 0% other, P = 0.06). Black race was associated with treatment (hazard ratio (HR) 2.93, P = 0.01) as compared with white. When the analysis was adjusted for socioeconomic and clinical parameters at the time of PC diagnosis, black race remained the sole predictor of treatment (HR 3.08, P = 0.01). Among men undergoing treatment, the trigger was less often patient driven in black men (8 black, 33 white, 67% other, P = 0.05). CONCLUSIONS Black race was associated with discontinuation of AS for treatment. This relationship persisted when adjusted for socioeconomic and clinical parameters.
Collapse
|
41
|
|
42
|
Diffusion-weighted and dynamic contrast-enhanced MRI of prostate cancer: correlation of quantitative MR parameters with Gleason score and tumor angiogenesis. AJR Am J Roentgenol 2012; 197:1382-90. [PMID: 22109293 DOI: 10.2214/ajr.11.6861] [Citation(s) in RCA: 200] [Impact Index Per Article: 16.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
OBJECTIVE The objective of our study was to investigate whether quantitative parameters derived from diffusion-weighted imaging (DWI) and dynamic contrast-enhanced MRI (DCE-MRI) correlate with Gleason score and angiogenesis of prostate cancer. MATERIALS AND METHODS Seventy-three patients who underwent preoperative MRI and radical prostatectomy were included in our study. A radiologist and pathologist located the dominant tumor on the MR images based on histopathologic correlation. For each dominant tumor, the apparent diffusion coefficient (ADC) value and quantitative DCE-MRI parameters (i.e., contrast agent transfer rate between blood and tissue [K(trans)], extravascular extracellular fractional volume [v(e)], contrast agent backflux rate constant [k(ep)], and blood plasma fractional volume on a voxel-by-voxel basis [v(p)]) were calculated and the Gleason score was recorded. The mean blood vessel count, mean vessel area fraction, and vascular endothelial growth factor (VEGF) expression of the dominant tumor were determined using CD31, CD34, and VEGF antibody stains. Spearman correlation analysis between MR and histopathologic parameters was conducted. RESULTS The mean tumor diameter was 15.2 mm (range, 5-28 mm). Of the 73 prostate cancer tumors, five (6.8%) had a Gleason score of 6, 46 (63%) had a Gleason score of 7, and 22 (30.1%) had a Gleason score of greater than 7. ADC values showed a moderate negative correlation with Gleason score (r = -0.376, p = 0.001) but did not correlate with tumor angiogenesis parameters. Quantitative DCE-MRI parameters did not show a significant correlation with Gleason score or VEGF expression (p > 0.05). Mean blood vessel count and mean vessel area fraction parameters estimated from prostate cancer positively correlated with k(ep) (r = 0.440 and 0.453, respectively; p = 0.001 for both). CONCLUSION There is a moderate correlation between ADC values and Gleason score and between k(ep) and microvessel density of prostate cancer. Although the strength of the correlations is insufficient for immediate diagnostic utility, these results warrant further investigation on the potential of multiparametric MRI to facilitate noninvasive assessment of prostate cancer aggressiveness and angiogenesis.
Collapse
|
43
|
Abstract
What's known on the subject? and What does the study add? Most men who are diagnosed with favourable-risk prostate cancer undergo some form of active intervention, despite evidence that treatment will not improve health outcomes for many. The decision to undergo treatment after diagnosis is, in part, related to the inability to precisely determine the long-term risk of harm without treatment. Nevertheless, physicians should consider patient age, overall health, and preferences for living with cancer and the potential side effects of curative treatments, before recommending a management option. This is especially important for older men, given the high level of evidence that those with low-risk disease are unlikely to accrue any benefit from curative intervention. What is known on the subject: Over treatment of favourable-risk prostate cancer is common, especially among older men. What does the study add: A review of the natural history of favourable-risk prostate cancer in the context of choices for management of the disease. • The management of favourable-risk prostate cancer is controversial, and in the absence of controlled trials to inform best practice, choices are driven by personal beliefs with resultant wide variation in practice patterns. • Men with favourable-risk prostate cancer diagnosed today often undergo treatments that will not improve overall health outcomes. • A shared-decision approach for selecting optimal management of favourable-risk disease should account for patient age, overall health, and preferences for living with cancer and the potential side effects of curative treatments.
Collapse
Affiliation(s)
- H Ballentine Carter
- Department of Urology, Johns Hopkins Hospital, Baltimore, MD 21287-2101, USA.
| |
Collapse
|
44
|
Corcoran NM, Casey RG, Hong MKH, Pedersen J, Connolly S, Peters J, Harewood L, Gleave ME, Costello AJ, Hovens CM, Goldenberg SL. The ability of prostate-specific antigen (PSA) density to predict an upgrade in Gleason score between initial prostate biopsy and prostatectomy diminishes with increasing tumour grade due to reduced PSA secretion per unit tumour volume. BJU Int 2011; 110:36-42. [PMID: 22085203 DOI: 10.1111/j.1464-410x.2011.10681.x] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
UNLABELLED Study Type - Diagnostic (exploratory cohort) Level of Evidence 2b What's known on the subject? and What does the study add? Due to sampling error, the Gleason score of clinically localized prostate cancer is frequently underestimated at the time of initial biopsy. Given that this may lead to inappropriate surveillance of patients with high-risk disease, there is considerable interest in identifying predictors of significant undergrading. Recently PSAD has been proposed to be an accurate predictor of subsequent upgrading in patients diagnosed with Gleason 6 disease on biopsy. We examined the predictive characteristics of PSAD in patients with low- and intermediate-risk disease on biopsy subsequently treated with radical prostatectomy. We found that although PSAD was a significant predictor of upgrade of biopsy Gleason 6 and 3 + 4 = 7 tumours, it failed to predict upgrading in patients with Gleason 7 tumours taken as a whole. When we explored reasons for this discrepancy, we found that the amount of PSA produced per unit tumour volume decreased with increasing Gleason score, thereby diminishing the predictive value of PSAD. OBJECTIVES To analyse the performance of PSA density (PSAD) as a predictor of Gleason score upgrade in a large cohort stratified by Gleason score. We and others have shown that an upgrade in Gleason score between initial prostate biopsy and final radical prostatectomy (RP) pathology is a significant risk factor for recurrence after local therapy. PATIENTS AND METHODS Patients undergoing RP with matching biopsy information were identified from two prospective databases. Patients were analysed according to the concordance between biopsy and final pathology Gleason score in three paired groups: 6/>6, 3 + 4/>3 + 4, 7/>7. Receiver-operating characteristic (ROC) curves were generated stratified by Gleason score, and the area under the curve (AUC) calculated. Logistic regression models were fitted to identify significant predictors of tumour upgrade. RESULTS From 1516 patients, 435 (29%) had an upgrade in Gleason score. ROC analysis showed a decline in AUC with increasing biopsy Gleason score, from 0.64 for biopsy Gleason score 6, to 0.57 for Gleason score 7. In logistic regression models containing pretreatment variables, e.g. clinical stage and number of positive cores, for Gleason score 6 and 3 + 4, PSAD was the strongest predictor of subsequent tumour upgrade (odds ratio [OR] 1.46, 95% confidence interval [95% CI] 1.18-1.83, P= 0.001 and OR 1.37, 95% CI 1.14-1.67, P= 0.002, respectively). Surprisingly, in tumours upgraded from Gleason score 7 to >7, PSAD was not predictive even on univariable analysis, whereas clinical stage and number of positive cores were significant independent predictors. To explore the relationship between serum PSA and Gleason score, tumour volume was calculated in 669 patients. There was a strong association between Gleason score and tumour volume, with the median volume of Gleason score 7 and Gleason score >7 tumours being approximately twice and four-times that of Gleason score 6 tumours, respectively (P < 0.001). In contrast, the median serum PSA level per millilitre tumour volume decreased significantly with increasing grade, from 5.4 ng/mL for Gleason score 6 to 2.1 ng/mL for >7 (P < 0.001). CONCLUSIONS There is a strong correlation between Gleason score and tumour volume in well/intermediate differentiated tumours, and as they produce relatively high amounts of PSA per unit volume of cancer, high PSAD is the strongest single predictor of tumour undergrading. However, as higher grade tumours produce less PSA per unit volume, PSAD loses its predictive ability, and other clinical markers of tumour volume such as palpable disease and numbers of positive cores become more predictive.
Collapse
Affiliation(s)
- Niall M Corcoran
- Department of Urological Sciences and Vancouver Prostate Centre, University of British Columbia, Vancouver, BC, Canada.
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
45
|
Ayres BE, Montgomery BS, Barber NJ, Pereira N, Langley SE, Denham P, Bott SR. The role of transperineal template prostate biopsies in restaging men with prostate cancer managed by active surveillance. BJU Int 2011; 109:1170-6. [DOI: 10.1111/j.1464-410x.2011.10480.x] [Citation(s) in RCA: 63] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
|
46
|
Al-Hussain T, Carter HB, Epstein JI. Significance of Prostate Adenocarcinoma Perineural Invasion on Biopsy in Patients Who are Otherwise Candidates for Active Surveillance. J Urol 2011; 186:470-3. [DOI: 10.1016/j.juro.2011.03.119] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2010] [Indexed: 10/18/2022]
Affiliation(s)
- Turki Al-Hussain
- Department of Pathology, The Johns Hopkins Hospital, Baltimore, Maryland
| | | | - Jonathan I. Epstein
- Department of Pathology, The Johns Hopkins Hospital, Baltimore, Maryland
- Department of Urology, The Johns Hopkins Hospital, Baltimore, Maryland
- Department of Oncology, The Johns Hopkins Hospital, Baltimore, Maryland
| |
Collapse
|
47
|
Lavery HJ, Levinson AW, Brajtbord JS, Samadi DB. Candidacy for active surveillance may be associated with improved functional outcomes after prostatectomy. Urol Oncol 2011; 31:187-92. [PMID: 21795076 DOI: 10.1016/j.urolonc.2010.11.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2010] [Revised: 11/19/2010] [Accepted: 11/22/2010] [Indexed: 10/17/2022]
Abstract
OBJECTIVE In an effort to curb overtreatment, active surveillance (AS) has grown in popularity as an option for men with low-risk prostate cancer. We evaluated the histopathologic and functional outcomes of patients who qualified for AS, but opted for robotic-assisted laparoscopic prostatectomy (RALP), and compared them to non-AS candidates. METHODS An institutional database of 1,477 RALP performed by a single surgeon was queried for AS candidates, defined as PSA <10 ng/mL, biopsy Gleason score ≤6 with a minimum of 10 biopsy cores, <3 positive cores with <50% tumor volume in a single core and clinical stage ≤T2a. RESULTS Of the 352 patients who would have qualified for AS, 159 (45%) were upgraded: 143 (41%) to Gl 3 + 4, 16 (4.5%) to 4 + 3, zero to Gleason 8 or higher. Seventeen (4.8%) patients were upstaged to pT3. AS candidates were younger and had more favorable tumor characteristics, but similar preoperative functional status. Bilateral nerve sparing was performed on 96% of AS candidates vs. 86% of non-AS candidates (P < 0.001). After 12 months of follow-up in patients who received bilateral nerve sparing, continence was higher in the AS cohort (98% vs. 92%, P < 0.001) but potency was equivalent (87% in each, P = 0.89). On multivariable analysis, candidacy for AS was independently associated with improved continence, but not potency. CONCLUSIONS In addition to having the expected favorable histopathologic features, AS candidates who desire definitive therapy have a high likelihood of achieving excellent functional outcomes, perhaps superior to non-AS candidates, following RALP.
Collapse
Affiliation(s)
- Hugh J Lavery
- Department of Urology, The Mount Sinai Medical Center, New York, NY 10022, USA.
| | | | | | | |
Collapse
|
48
|
Suardi N, Gallina A, Capitanio U, Salonia A, Lughezzani G, Freschi M, Mottrie A, Rigatti P, Montorsi F, Briganti A. Age-adjusted validation of the most stringent criteria for active surveillance in low-risk prostate cancer patients. Cancer 2011; 118:973-80. [DOI: 10.1002/cncr.26234] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2010] [Revised: 03/30/2011] [Accepted: 04/11/2011] [Indexed: 11/06/2022]
|
49
|
Sooriakumaran P, Srivastava A, Christos P, Grover S, Shevchuk M, Tewari A. Predictive models for worsening prognosis in potential candidates for active surveillance of presumed low-risk prostate cancer. Int Urol Nephrol 2011; 44:459-70. [PMID: 21706297 DOI: 10.1007/s11255-011-0020-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2011] [Accepted: 06/07/2011] [Indexed: 10/18/2022]
Abstract
PURPOSE Low-risk prostate cancer patients clinically eligible for active surveillance can also be managed surgically. We evaluated the pathologic outcomes for this cohort that was treated by radical prostatectomy and devised nomograms to predict patients at risk of upgrading and/or upstaging. MATERIALS AND METHODS Seven hundred and fifty patients treated by radical prostatectomy from Jan 2005 to the present fulfilled conventional active surveillance criteria and formed the study cohort. Preoperative data on standard clinicopathologic parameters were available. The radical prostatectomy specimens were graded and staged, and any upgrading to Gleason sum >6 or upstaging to ≥pT3 ('worsening prognosis') were noted. Multivariable logistic regression models were used to develop predictive nomograms. RESULTS Of the 750 patients, 303 (40.4%) patients were either upgraded or upstaged. Multivariable analysis found that preoperative PSA, number of positive cores, and prostate volume were significantly predictive of worsening prognosis and formed the nomogram criteria. CONCLUSIONS Of patients deemed eligible for active surveillance based on conventional criteria, 40.4% have worse prognostic factors after radical prostatectomy. Current active surveillance criteria may be too relaxed, and the use of nomograms which we have devised, may aid in counseling primary prostate cancer patients considering active surveillance as their therapy of choice.
Collapse
Affiliation(s)
- Prasanna Sooriakumaran
- Department of Urology, Lefrak Center of Robotic Surgery & Institute of Prostate Cancer, Weill Cornell Medical College, James Buchanan Brady Foundation, New York, NY 10065, USA
| | | | | | | | | | | |
Collapse
|
50
|
Tosoian JJ, Trock BJ, Landis P, Feng Z, Epstein JI, Partin AW, Walsh PC, Carter HB. Active Surveillance Program for Prostate Cancer: An Update of the Johns Hopkins Experience. J Clin Oncol 2011; 29:2185-90. [PMID: 21464416 DOI: 10.1200/jco.2010.32.8112] [Citation(s) in RCA: 485] [Impact Index Per Article: 37.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Purpose We assessed outcomes of men with prostate cancer enrolled in active surveillance. Patients and Methods Since 1995, a total of 769 men diagnosed with prostate cancer have been followed prospectively (median follow-up, 2.7 years; range, 0.01 to 15.0 years) on active surveillance. Enrollment criteria were for very-low-risk cancers, defined by clinical stage (T1c), prostate-specific antigen density < 0.15 ng/mL, and prostate biopsy findings (Gleason score ≤ 6, two or fewer cores with cancer, and ≤ 50% cancer involvement of any core). Curative intervention was recommended on disease reclassification on the basis of biopsy criteria. The primary outcome was survival free of intervention, and secondary outcomes were rates of disease reclassification and exit from the program. Outcomes were compared between men who did and did not meet very-low-risk criteria. Results The median survival free of intervention was 6.5 years (range, 0.0 to 15.0 years) after diagnosis, and the proportions of men remaining free of intervention after 2, 5, and 10 years of follow-up were 81%, 59%, and 41%, respectively. Overall, 255 men (33.2%) underwent intervention at a median of 2.2 years (range, 0.6 to 10.2 years) after diagnosis; 188 men (73.7%) underwent intervention on the basis of disease reclassification on biopsy. The proportions of men who underwent curative intervention (P = .026) or had biopsy reclassification (P < .001) were significantly lower in men who met enrollment criteria than in those who did not. There were no prostate cancer deaths. Conclusion For carefully selected men, active surveillance with curative intent appears to be a safe alternative to immediate intervention. Limiting surveillance to very-low-risk patients may reduce the frequency of adverse outcomes.
Collapse
Affiliation(s)
- Jeffrey J. Tosoian
- From the Johns Hopkins University School of Medicine, The James Buchanan Brady Urological Institute, and Johns Hopkins Hospital, Baltimore, MD
| | - Bruce J. Trock
- From the Johns Hopkins University School of Medicine, The James Buchanan Brady Urological Institute, and Johns Hopkins Hospital, Baltimore, MD
| | - Patricia Landis
- From the Johns Hopkins University School of Medicine, The James Buchanan Brady Urological Institute, and Johns Hopkins Hospital, Baltimore, MD
| | - Zhaoyong Feng
- From the Johns Hopkins University School of Medicine, The James Buchanan Brady Urological Institute, and Johns Hopkins Hospital, Baltimore, MD
| | - Jonathan I. Epstein
- From the Johns Hopkins University School of Medicine, The James Buchanan Brady Urological Institute, and Johns Hopkins Hospital, Baltimore, MD
| | - Alan W. Partin
- From the Johns Hopkins University School of Medicine, The James Buchanan Brady Urological Institute, and Johns Hopkins Hospital, Baltimore, MD
| | - Patrick C. Walsh
- From the Johns Hopkins University School of Medicine, The James Buchanan Brady Urological Institute, and Johns Hopkins Hospital, Baltimore, MD
| | - H. Ballentine Carter
- From the Johns Hopkins University School of Medicine, The James Buchanan Brady Urological Institute, and Johns Hopkins Hospital, Baltimore, MD
| |
Collapse
|