Active surveillance for prostate cancer

Tay, Kae Jack; Méndez, Melissa; Moul, Judd W.; Polascik, Thomas J.

doi:10.1097/mou.0000000000000168

Cited by 27 publications

(3 citation statements)

References 47 publications

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“… 2 , 3 Given this fact, the traditional therapeutic modalities such as surgery, chemotherapy therapy and androgen ablation therapy are only modestly effective. 4 , 5 Therefore, understanding the molecular mechanisms contributing to PCa progression could provide insights into effective therapeutic strategies.…”

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confidence: 99%

Ligand-dependent EphA7 signaling inhibits prostate tumor growth and progression

et al. 2017

Cell Death Dis

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The downregulation of receptor tyrosine kinase EphA7 is frequent in epithelial cancers and linked to tumor progression. However, the detailed mechanism of EphA7-mediated prostate tumor progression remains elusive. To test the role of EphA7 receptor in prostate cancer (PCa) progression directly, we generated EphA7 receptor variants that were either lacking the cytoplasmic domain or carrying a point mutation that inhibits its phosphorylation by site-directed mutagenesis. Overexpression of wild-type (WT) EphA7 in PCa cells resulted in decreased tumor volume and increased tumor apoptosis in primary tumors. In addition, ectopic expression of WT EphA7 both can delay PCa cell proliferation and could inhibit PCa cell migration and invasion. This protein can also induce PCa cell apoptosis that correlated with increasing the protein expression levels of Bax, elevating the caspase-3 activities, reducing the protein expression levels of Bcl-2 and facilitating the dephosphorylation of Akt, which is further increased by the stimulation of ephrinA5-Fc. However, expression of these EphA7 mutants in PCa cells has no effect in vivo and in vitro. The expression of EphA7 and ephrinA5 was significantly decreased in PCa specimens compared with BPH tissues or paired normal tissues. Moreover, the phosphorylation of EphA7 was positively related with ephrinA5 expression in human prostate tissues. In sum, receptor phosphorylation of EphA7, at least in part, suppress PCa tumor malignancy through targeting PI3K/Akt signaling pathways.

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confidence: 99%

Ligand-dependent EphA7 signaling inhibits prostate tumor growth and progression

et al. 2017

Cell Death Dis

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“…As such, there is a need to improve protocols to improve patient selection and the outcomes for AS, including the use of saturation template biopsy, molecular biomarkers, and imaging [ 23 ].…”

Section: Conventional Active Surveillance Protocolsmentioning

confidence: 99%

Multiparametric MRI in Active Surveillance of Prostate Cancer: An Overview and a Practical Approach

Lee

Tan

2021

Korean J Radiol

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MRI has become important for the detection of prostate cancer. MRI-guided biopsy is superior to conventional systematic biopsy in patients suspected with prostate cancer. MRI is also increasingly used for monitoring patients with low-risk prostate cancer during active surveillance. It improves patient selection for active surveillance at diagnosis, although its role during follow-up is unclear. We aim to review existing evidence and propose a practical approach for incorporating MRI into active surveillance protocols.

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“…Indeed, among post-prostatectomy cohorts, men who initially fulfilled low-risk criteria had a 30%–50% chance of harboring higher-grade cancer upon complete examination of the prostate [6] . Efforts to address the weaknesses of conventional biopsy and better stratify patients for AS or treatment have now led to a proliferation of imaging, imaging-guided biopsy, mapping biopsy and biomarker tests [7] .…”

Section: Introductionmentioning

confidence: 99%

Outcomes of combination MRI-targeted and transperineal template biopsy in restaging low-risk prostate cancer for active surveillance

Chen

Tay

Law

et al. 2018

Asian Journal of Urology

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ObjectiveActive surveillance (AS) offers a strategy to reduce overtreatment and now is a widely accepted treatment option for low-risk prostate cancer. An ideal tool for risk-stratification would detect aggressive cancers and exclude such men from taking up AS in the first place. We evaluate if a combination of transperineal template biopsy with magnetic resonance imaging (MRI)-targeted biopsy identifies significant prostate cancer amongst men initially diagnosed with low-risk prostate cancer.MethodsThis prospective, single-blinded study included men with low-risk prostate cancer (D'Amico's Criteria) diagnosed on conventional transrectal ultrasound-guided biopsy. Patients first underwent multiparametric MRI of the prostate ≥6 weeks after initial biopsy. Each suspicious lesion is mapped and assigned a Prostate Imaging Reporting and Data System (PIRADS) score. Template biopsy is first performed with the surgeon blinded to MRI findings followed by MRI-targeted biopsy using a robotic transperineal biopsy platform.ResultsThe age of the 19 men included is 65.4 ± 4.9 years (mean ± SD). Prostate specific antigen (PSA) at diagnosis and at the time of transperineal biopsy were comparable (7.3 ± 1.7 ng/mL and 7.0 ± 1.8 ng/mL, p = 0.67), so were prostate volumes (34.2 ± 8.9 mL and 32.1 ± 13.4 mL, p = 0.28). MRI-targeted biopsy had a higher percentage of cancer detection per core compared to template biopsy (11.7% vs. 6.5%, p = 0.02), this was more than 3 times superior for Gleason 7 disease (5.9% vs. 1.6%, p < 0.01). Four of 18 (22.2%) patients with MRI lesions had significant disease with MRI-targeted biopsy alone. Three of 19 patients (15.8%) had significant disease with template biopsy alone. In combination, both techniques upclassified five patients (26.3%), all of whom underwent radical prostatectomy. Whole mount histology confirmed tumour location and grade. All six patients with PIRADS 5 lesions had cancer detected (66.6% significant disease).ConclusionA combination of MRI-targeted and template biopsy may optimally risk-classify “low-risk” patients diagnosed on initial conventional transrectal ultrasonography (TRUS) prostate biopsy.

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Active surveillance for prostate cancer

Abstract: Active surveillance protocols should be modernized to include cancer localization modalities and molecular prognostic markers to improve tumour characterization and better stratify men to surveillance, focal or radical intervention.

Cited by 27 publications

References 47 publications

Ligand-dependent EphA7 signaling inhibits prostate tumor growth and progression

Ligand-dependent EphA7 signaling inhibits prostate tumor growth and progression

Multiparametric MRI in Active Surveillance of Prostate Cancer: An Overview and a Practical Approach

Outcomes of combination MRI-targeted and transperineal template biopsy in restaging low-risk prostate cancer for active surveillance

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