A Decade of Active Surveillance in the PRIAS Study: An Update and Evaluation of the Criteria Used to Recommend a Switch to Active Treatment

Bokhorst, Leonard P.; Valdagni, Riccardo; Rannikko, Antti; Kakehi, Yoshiyuki; Pickles, Tom; Bangma, Chris H.; Roobol, Monique J.

doi:10.1016/j.eururo.2016.06.007

Cited by 325 publications

(329 citation statements)

References 21 publications

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“…Of the 30 (6%) patients who No. of follow-up visits 11 [5][6][7][8][9][10][11][12][13][14][15][16][17][18] Data presented as median (IQR) or n (%). PSA, prostate specific antigen; IQR, interquartile range.…”

Section: Resultsmentioning

confidence: 99%

“…Patients who already were under surveillance before official initiation of PRIAS were only included if the PRIAS followup protocol had been applied. These 500 patients have been part of previous reports (13)(14)(15).…”

Section: Study Populationmentioning

confidence: 99%

“…The recommended criteria for inclusion were Gleason score (GS) ≤3+3, stage ≤ cT2c, PSA ≤10 ng/mL, ≤2 cores positive for PCa, PSA-density ≤0.2 ng/mL/cm 3 , and fitness for curative treatment (13). The recommended follow-up strategy during the first 2 years after diagnosis was a PSA test every 3 months and a digital rectal examination (DRE) every 6 months.…”

Section: Prias Protocolmentioning

confidence: 99%

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Can active surveillance really reduce the harms of overdiagnosing prostate cancer? A reflection of real life clinical practice in the PRIAS study

Drost¹,

Bangma²,

Kakehi³

et al. 2018

European Urology Supplements

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Background: Active surveillance (AS) for low-risk prostate cancer (PCa) appears to provide excellent longterm PCa-specific and overall survival. The choice for AS as initial treatment is mainly based on avoiding side effects from invasive treatment; but AS entails regular check-ups and the possibility of still having to switch or deciding to switch to invasive treatment. Here, we assessed the long-term follow-up data from AS in real life clinical practices.Methods: Data from the first 500 men, enrolled in PRIAS before July 2008 by 30 centers across 8 countries, were analyzed to provide long-term follow-up results. Men were advised to be regularly examined with prostate-specific antigen (PSA) tests, digital rectal examinations, and prostate biopsies. Men were advised to switch to invasive treatment if they had disease reclassification [Gleason score (GS) ≥3+4 on biopsy, more than two positive biopsy cores, a stage higher than cT2] or a PSA-doubling time of 0-3 years.We assessed time on AS, outcomes and reasons for discontinuing AS, and rates of potential unnecessary biopsies and treatments.Results: The median follow-up time was 6.5 years. During this period, 325 (65%) men discontinued after a median of 2.3 years and 121 (24%) men had no recent (>1 year) data-update after a median of 7.3 years. The remaining 54 (11%) men were confirmed to be still on AS. Most men discontinued based on protocol advice; 38% had other reasons. During follow-up, 838 biopsy sessions were performed of which 79% to 90% did not lead to reclassification, depending on the criteria. Of the 325 discontinued men, 112 subsequently underwent radical prostatectomy (RP), 126 underwent radiotherapy, 57 switched to watchful waiting (WW) or died, and 30 had another or unknown treatment. RP results were available of 99 men: 34% to 68%, depending on definition, had favorable outcomes; 50% of unfavorable the outcomes occurred in the first 2 years. Of the 30 (6%) men who died, 1 man died due to PCa.Conclusions: These data, reflecting real life clinical practice, show that more than half of men switched to invasive treatment within 2.3 years, indicating limitations to the extent in which AS is able to reduce the * All contributors to the data in this paper are listed in the Table S1. IntroductionSince the use of prostate specific antigen (PSA) testing, the majority of newly diagnosed prostate cancer (PCa) patients are considered to have low risk of progression (1). Although PSA screening leads to a PCa mortality reduction, overdiagnosis and overtreatment of these low-risk PCa patients are still a substantial concern (1-4). To prevent overtreatment, active surveillance (AS) is increasingly recognized as a favorable alternative to direct radical therapy for men with low-risk PCa (5-8). Considering all relevant data, the US Preventive Services Task Force (USPSTF) has recently proposed to endorse physicians to counsel men on PSA screening (9). This change in the USPSTF recommendation is heavily based on a modeling study which suggests that greater use of AS ...

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Section: Resultsmentioning

confidence: 99%

Section: Study Populationmentioning

confidence: 99%

Section: Prias Protocolmentioning

confidence: 99%

See 1 more Smart Citation

Can active surveillance really reduce the harms of overdiagnosing prostate cancer? A reflection of real life clinical practice in the PRIAS study

Drost¹,

Bangma²,

Kakehi³

et al. 2018

European Urology Supplements

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“…Voorwaarde voor inclusie was beschikbaarheid van een recente serum-PSA-waarde, alsmede een histopathologisch rapport van de prostaatbiopten. Het aantal te nemen weefselbiopten is afhankelijk van het prostaatvolume (cc), zoals beschreven in de PRIAS-studie [10]. Deelname aan het onderzoek was niet mogelijk bij een maligniteit in de voorgeschiedenis of tekenen van een actieve infectie, om mogelijke interferentie met de data te voorkomen.…”

Section: Materiaal En Methodenunclassified

Opsporen van prostaatkanker in uitademingslucht met behulp van een draagbare elektronische neus

Waltman

Roermund

2018

Tijdschr Urol

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SamenvattingDe laatste jaren zijn verschillende non-invasieve technieken onderzocht om opsporing van prostaatkanker te verbeteren. Dit onderzoek gaat over de analyse van uitademingslucht door een geavanceerde, gebruiksvriendelijke en draagbare elektronische neus, de Aeonose Trefwoorden prostaatkanker · uitademingslucht · elektronische neus · volatile organic compound (VOC)Detecting prostate cancer by analyzing exhaled-breath using a portable electronic nose (Aeonose TM ) Abstract In the last decade, several non-invasive methods have been researched in order to improve detection of prostate cancer (PCa). This study investigated the possibility of detecting PCa based on exhaled-breath analysis using an advanced, easy-to-use, portable electronic nose ('Aeonose TM '). Exhaled-breath was probed from 85 patients. Within this population, 32 were diagnosed with primary PCa, and 53 patients were used as controls: 30 having negative biopsies, 23 with benign prostate hyperplasia. In order to differentiate between groups, an artificial neural network was trained. This trained model showed an area under the curve of 0.79 with a sensitivity and specificity of 0.84 (95% CI = 0.66-0.94) and 0.70 (95% CI = 0.55-0.81) respectively, when comparing primary PCa and controls. Negative predictive value found was 0.88. In conclusion, these promising results imply Aeonose™ exhaled-breath analysis can be used to detect PCa.Keywords prostate cancer · exhaled-breathe · electronic nose · volatile organic compounds (VOCs) IntroductieAl sinds de Griekse oudheid is bekend dat uitademingslucht informatie bevat over iemands gezondheidstoestand. Uit onderzoek is gebleken dat honden een zeer goed ontwikkeld reukorgaan hebben en concentraties van 0,001 deeltjes

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“…[4][5][6] Then why do we treat the disease at all? Firstly, patients opt for treatment because the term cancer invokes a fear of death, and we instinctively avoid death and any associated anxiety.…”

mentioning

confidence: 99%

Photodynamic therapy for low risk prostate cancer

Ritch

Punnen

2017

BMJ

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A Decade of Active Surveillance in the PRIAS Study: An Update and Evaluation of the Criteria Used to Recommend a Switch to Active Treatment

Abstract: We confirmed the safety of active surveillance as a treatment option for men with low-risk prostate cancer; however, some changes could be made to the follow-up protocol to safely increase the number of men who remain on active surveillance.

Cited by 325 publications

References 21 publications

Can active surveillance really reduce the harms of overdiagnosing prostate cancer? A reflection of real life clinical practice in the PRIAS study

Can active surveillance really reduce the harms of overdiagnosing prostate cancer? A reflection of real life clinical practice in the PRIAS study

Opsporen van prostaatkanker in uitademingslucht met behulp van een draagbare elektronische neus

Photodynamic therapy for low risk prostate cancer

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