Active surveillance for clinically localized prostate cancer––A systematic review

Thomsen, Frederik Birkebæk; Brasso, Klaus; Klotz, Laurence; Røder, Martin Andreas; Berg, Kasper Drimer; Iversen, Peter

doi:10.1002/jso.23584

Cited by 156 publications

(116 citation statements)

References 65 publications

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“…Less frequent re-biopsies are a reason for the difference in therapy switches, as progression established on a re-biopsy was the main reason for a therapy switch in both groups. Clinical studies also show an AS discontinuation rate of 14-41% in the first 3 years, mainly because of histological evidence of progression [9]. The proportion of patients in whom therapy was switched without evidence of progression is similar in both groups (16.6 vs 18.9%), and is higher than reported in clinical AS studies (1-8.7%) [9].…”

Section: Totalmentioning

confidence: 80%

“…Clinical studies also show an AS discontinuation rate of 14-41% in the first 3 years, mainly because of histological evidence of progression [9]. The proportion of patients in whom therapy was switched without evidence of progression is similar in both groups (16.6 vs 18.9%), and is higher than reported in clinical AS studies (1-8.7%) [9]. These therapy switches are divided into 'patient's request' and 'doctor's recommendation' in both groups and show that some patients request invasive therapy for fear of progression and some physicians are uncertain about using AS.…”

Section: Totalmentioning

confidence: 99%

“…For many years AS has been the recommended strategy for low-risk prostate cancer (PCa) [6,7]. Most prospective AS studies relate to patients with PCa diagnosed by core needle biopsies (T1c or T2a) and have reported cancer-specific 10-year survival rates of 98% [8] as well as a switch to deferred treatment in 14-41% of patients [9]. By contrast, there are few studies on patients with IPCa on AS and these are mostly retrospective.…”

Section: Introductionmentioning

confidence: 99%

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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

Herden

Wille

Weißbach³

2015

BJU International

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ObjectiveTo 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 MethodsThe 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. ResultsOut 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. ConclusionUrologists 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.

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Section: Totalmentioning

confidence: 80%

Section: Totalmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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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

Herden

Wille

Weißbach³

2015

BJU International

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“…A systematic review has summarised the available data on AS [40]. There is considerable heterogeneity between studies regarding patient selection, follow-up policies and when active treatment should be instigated.…”

Section: Active Surveillance and Watchful Waitingmentioning

confidence: 99%

EAU-ESTRO-SIOG Guidelines on Prostate Cancer. Part 1: Screening, Diagnosis, and Local Treatment with Curative Intent

et al. 2017

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“…In Sweden, the proportion of men managed with AS has increased from 55% in 2009 to 85% in 2013 [10]. Men with localised, low-risk PCa with life expectance of more than ten years without serious comorbidity contraindicating curative treatment may preferably be managed with the AS strategy [109]. By the application of surveillance instead of immediate curative treatment, sideeffects and impaired quality of life caused by overtreatment may be avoided.…”

Section: Watchful Waitingmentioning

confidence: 99%

Disease-Specific Survival in Prostate Cancer Patients : Results from the Scandinavian Prostate Cancer Group (SPCG) Trial No. 5 and Regional Cancer Register Data

Klaff¹

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Introduction Prostate cancer (PCa) is the most common cancer among men in Sweden. The clinical course varies considerably, which makes it difficult to predict the prognosis in the individual case. In order to explore the early as well as the late course of the disease, large study groups and population-based cohorts are necessary. Aims To explore factors that influence the long-term outcome of men with low-risk tumours in a population-based register, to predict the long-term course, and to assess the mortality rate for men with prostate cancer (Paper I) To analyse long-term outcome and to investigate factors associated with long-term survival in patients with metastases to the skeleton (Paper II) To analyse early androgen deprivation treatment (ADT) failure and to define clinical predictors associated with short survival due to early ADT failure in prostate cancer patients with bone metastases (Paper III) To analyse the prognostic significance of the extent of bone metastases in relation to other pretreatment variables in prostate cancer patients, and to explore the impact of bone metastases on quality-of-life (Paper IV) Material and methods The study groups were assembled from The South East Region Prostate Cancer Register (SERPCR), and The Scandinavian Prostate Cancer Group (SPCG) Trial No. 5. In the first study, prognostic factors and long-term disease-specific mortality rates of low-risk prostate cancer patients from the early PSA era were analysed. In the second study, patient-related factors, quality-of-life (QoL) and long-term survival in 915 PCa patients with bone metastases (M1b) under ADT, were analysed. In Study III factors predicting primary failure to respond to ADT were identified. Study IV explored the impact of the extent of bone metastases on survival and QoL for these men. Result and conclusions The long-term disease-specific mortality of low-risk localised PCa is low, but the annual mortality rate gradually increases. This indicates that some tumours slowly develop into lethal cancer, particularly in men 70 years or older and with a PSA level ≥ 4 μg/L. From the SPCG Trial No. 5, a subgroup of patients with M1b disease and favourable set of predictive factors survived more than 10 years under ADT with an acceptable QoL. Independent predictors of long-term survival were identified as performance status (PS) < 2, limited extent of bone metastases, and a PSA level < 231 μg/L at the time of enrolment in the trial. However, four independent clinical predictors of early ADT failure could be defined. Men exhibiting these features should be considered for an alternative treatment. Patient grouping based on three categories of extent of bone metastases related to PS, haemoglobin, and QoL at presentation, as independent predictors of mortality, may provide improved accuracy of prognosis

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Active surveillance for clinically localized prostate cancer––A systematic review

Cited by 156 publications

References 65 publications

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

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

EAU-ESTRO-SIOG Guidelines on Prostate Cancer. Part 1: Screening, Diagnosis, and Local Treatment with Curative Intent

Disease-Specific Survival in Prostate Cancer Patients : Results from the Scandinavian Prostate Cancer Group (SPCG) Trial No. 5 and Regional Cancer Register Data

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