Active Surveillance is an Appropriate Management Strategy for a Proportion of Men Diagnosed with Prostate Cancer by Prostate Specific Antigen Testing

Overholser, Stephen; Nielsen, Matthew; Torkko, Kathleen C.; Cwilka, Daniel; Weaver, Brandi; Shi, Xiaoyu; Leach, Robin J.; Hernández, Javier; Huang, Tim Hui-Ming; Thompson, Ian M.

doi:10.1016/j.juro.2015.01.089

Cited by 14 publications

(13 citation statements)

References 17 publications

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“…2 Although >95% of men in the work by Epstein and colleagues were White non-Hispanic men, the ethnicity of contemporary men diagnosed with PCa is significantly more diverse. 2,6,7 Hispanics are the largest and the most rapidly growing ethnic minority in the United States, and it is predicted that Hispanics will comprise a third of the population by 2060 (http://www.cdc.gov/minorityhealth/populations/REMP/hispanic.html; http://edr.state.fl.us/Content/population-demographics/data/Methodology_Projections_ARSH.pdf). To date, there has been no detailed clinicopathologic analysis of RP findings in Hispanic men qualifying for AS.…”

Section: Discussionmentioning

confidence: 99%

“…In part, this is due to robust screening, which has resulted in a larger proportion of men contemporarily diagnosed with PCa who are candidates for AS. 2 These AS criteria were adopted by The National Comprehensive Cancer Network (NCCN) and are widely accepted. 3 Men defined as having very low-risk PCa should have a prostate-specific antigen (PSA) density (PSAD)≤0.15 ng/mL/g, unremarkable digital rectal examination (stage T1c), involvement of 2 or less biopsy cores with Gleason score 3+3 = 6 (Grade Group [GG] 1) disease, and 50% or less involvement of any single core.…”

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confidence: 99%

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Radical Prostatectomy Findings in White Hispanic/Latino Men With NCCN Very Low-risk Prostate Cancer Detected by Template Biopsy

Kryvenko

Lyapichev

Chinea

et al. 2016

American Journal of Surgical Pathology

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Radical prostatectomy (RP) outcomes have been studied in White and Black non-Hispanic men qualifying for Epstein active surveillance criteria (EASC). Herein, we first analyzed such outcomes in White Hispanic men. We studied 70 men with nonpalpable Gleason score 3+3 = 6 (Grade Group [GG] 1) prostate cancer (PCa) with ≤2 positive cores on biopsy who underwent RP. In 18 men, prostate-specific antigen (PSA) density (PSAD) was >0.15 ng/mL/g. Three of these had insignificant and 15 had significant PCa. The remaining 52 men qualified for EASC. One patient had no PCa identified at RP. Nineteen (37%) had significant PCa defined by volume (n = 7), grade (n = 7), and volume and grade (n = 5). Nine cases were 3+4 = 7 (GG 2) (5/9 [56%] with pattern 4 <5%), 2 were 3+5 = 8 (GG 4), and 1 was 4+5 = 9 (GG 5). Patients with significant PCa more commonly had anterior dominant disease (11/19, 58%) versus patients with insignificant cancer (7/33, 21%) (P = 0.01). In 12 cases with higher grade at RP, the dominant tumor nodule was anterior in 6 (50%) and posterior in 6 (median volumes: 1.1 vs. 0.17 cm3, respectively; P = 0.01). PSA correlated poorly with tumor volume (r = 0.28, P = 0.049). Gland weight significantly correlated with PSA (r = 0.54, P < 0.001). While PSAD and PSA mass density correlated with tumor volume, only PSA mass density distinguished cases with significant disease (median, 0.008 vs. 0.012 μg/g; P = 0.03). In summary, a PSAD threshold of 0.15 works well in predicting significant tumor volume in Hispanic men. EASC appear to perform better in White Hispanic men than previously reported outcomes for Black non-Hispanic and worse than in White non-Hispanic men. Significant disease is often Gleason score 3+3 = 6 (GG 1) PCa >0.5 cm3. Significant PCa is either a larger-volume anterior disease that may be detected by multi-parametric magnetic resonance imaging-targeted biopsy or anterior sampling of the prostate or higher-grade smaller-volume posterior disease that in most cases should not pose immediate harm and may be detected by repeat template biopsies.

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Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

Radical Prostatectomy Findings in White Hispanic/Latino Men With NCCN Very Low-risk Prostate Cancer Detected by Template Biopsy

Kryvenko

Lyapichev

Chinea

et al. 2016

American Journal of Surgical Pathology

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“…Research data from other countries suggest that up to two thirds of pca patients could be safely managed with active surveillance [6][7][8] . Recently published findings from a clinical trial in Canada following more than 900 pca patients on active surveillance suggest that low-risk pca patients can be managed safely with active surveillance for 15 years 4 .…”

Section: Discussionmentioning

confidence: 99%

Treatment Patterns among Canadian Men Diagnosed with Localized Low-Risk Prostate Cancer

et al. 2015

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In general, guideline-recommended treatment options for men with low-risk prostate cancer (pca) include active surveillance, radical prostatectomy, and external-beam radiation therapy or brachytherapy. Because of the concern about overdiagnosis and consequent overtreatment of pca, patients with low-risk disease are increasingly being managed with active surveillance. Using data from six provincial cancer registries, we examined treatment patterns within a year of a diagnosis of localized low-risk pca, and we assessed differences by age.Of patients diagnosed in 2010 in four of the six reporting provinces, most received surgery or radiation therapy within 1 year of diagnosis. Depending on the province, either surgery or radiation therapy was the most commonly used primary treatment. In the other two provinces, most patients had no record of treatment within a year of diagnosis. Examining treatment patterns by age demonstrated a lesser likelihood of receiving surgery or radiation therapy within 1 year of diagnosis among men more than 75 years of age than among men 75 years of age or younger (no record of treatment in 69.1% and 46.3% respectively).In conclusion, we observed interprovincial and age-specific variations in the patterns of care for men with lowrisk pca. The findings presented in this report are intended to identify opportunities for improvement in clinical practice that could lead to improved care and experience.

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“…Since indolent tumors are slow growing with low risk of progression, active surveillance is imposed for this population of patients [14]. Meanwhile, distinguishing the indolent cases from aggressive malignancies is challenging [3].…”

Section: A Prostate Cancer Managementmentioning

confidence: 99%

“…Active surveillance with minimum intervention for low risk indolent patients is beneficial in practice because it reduces unnecessary invasive treatment [14, 17, 18]. Patient’s psychological stress during active surveillance has become a new challenge due to the anxiety associated with a cancer diagnosis [19].…”

Section: A Prostate Cancer Managementmentioning

confidence: 99%

Glycogen synthase kinase-3: A potential preventive target for prostate cancer management

Thrasher

Terranova

2015

Urologic Oncology: Seminars and Original Investigations

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Prostate cancers are the frequently diagnosed cancers in men and patients with metastatic disease only have 28% chance for 5-year survival. Patients with low risk tumors are subjected to active surveillance while high risk cases are actively treated. Unfortunately, there is no cure for late-stage patients. Glycogen synthase kinase-3 (GSK-3, α and β) is a protein serine/threonine kinase and has diverse cellular functions and numerous substrates. Accumulating evidence indicates that GSK-3α is mainly expressed in low-risk prostate cancers and is related to hormone-dependent androgen receptor (AR)-mediated gene expression, while GSK-3β is mainly expressed in high-risk prostate cancers and is related to hormone-independent AR-mediated gene expression. GSK-3 has been demonstrated as a positive regulator in AR transactivation and prostate cancer growth independent of the Wnt/β-catenin pathway. Different types of GSK-3 inhibitors including lithium show promising results in suppressing tumor growth in different animal models of prostate cancer. Importantly, clinical use of lithium is associated with reduced cancer incidence in psychiatric patients. Taken together, GSK-3 inhibition might be implicated in prostate cancer management as a preventive treatment.

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Active Surveillance is an Appropriate Management Strategy for a Proportion of Men Diagnosed with Prostate Cancer by Prostate Specific Antigen Testing

Abstract: In a population based cohort, two-thirds of men diagnosed with prostate cancer qualify for active surveillance. Less restricted criteria for surveillance may be appropriate based on similar rates of upgrading/up staging at radical prostatectomy.

Cited by 14 publications

References 17 publications

Radical Prostatectomy Findings in White Hispanic/Latino Men With NCCN Very Low-risk Prostate Cancer Detected by Template Biopsy

Radical Prostatectomy Findings in White Hispanic/Latino Men With NCCN Very Low-risk Prostate Cancer Detected by Template Biopsy

Treatment Patterns among Canadian Men Diagnosed with Localized Low-Risk Prostate Cancer

Glycogen synthase kinase-3: A potential preventive target for prostate cancer management

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