Contemporary Management of Incident Prostate Cancer in Large Community Urology Practices in the United States

Shelton, Jeremy B.; Buffington, Phil; Augspurger, Richard R.; Gaylis, Franklin; Cohen, Todd; Mehlhaff, Bryan A.; Suh, Ronald S.; Bradford, Timothy J.; Kwan, Lorna; Koo, Alec S.; Shore, Neal D.

doi:10.1016/j.urology.2019.01.061

Cited by 6 publications

(2 citation statements)

References 23 publications

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“…Since many IPCs have a low progression rate [3] and up to 30% of specimens after subsequent RP do not exhibit residual tumor (pT0) [4], it remains unclear which patients benefit from invasive treatment (RP, RT, and HT) and which benefit from noninvasive management (AS and WW). In recent years, AS has been increasingly used in patients with low-risk prostate cancer [5, 6] and is therefore also suitable for patients with IPC and a favorable risk profile. In contrast to the palliative WW, AS implies curative intention.…”

Section: Introductionmentioning

confidence: 99%

Active Surveillance for Incidental (cT1a/b) Prostate Cancer: Long-Term Outcomes of the Prospective Noninterventional HAROW Study

Herden

Schwarte

Boedefeld³

et al. 2021

Urol Int

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Introduction: Optimal treatment for incidental prostate cancer (IPC) after surgical treatment for benign prostate obstruction is still debatable. We report on long-term outcomes of IPC patients managed with active surveillance (AS) in a German multicenter study. Methods: HAROW (2008–2013) was designed as a noninterventional, prospective, health-service research study for patients with localized prostate cancer (≤cT2), including patients with IPC (cT1a/b). A follow-up examination of all patients treated with AS was carried out. Overall, cancer-specific, and metastasis-free survival and discontinuation rates were determined. Results: Of 210 IPC patients, 68 opted for AS and were available for evaluation. Fifty-four patients had cT1a category and 14 cT1b category. Median follow-up was 7.7 years (IQR: 5.7–9.1). Eight patients died of which 6 were still under AS or watchful waiting (WW). No PCa-specific death could be observed. One patient developed metastasis. Twenty-three patients (33.8%) discontinued AS changing to invasive treatment: 12 chose radical prostatectomy, 7 radiotherapy, and 4 hormonal treatment. Another 19 patients switched to WW. The Kaplan-Meier estimated 10-year overall, cancer-specific, metastasis-free, and intervention-free survival was 83.8% (95% CI: 72.2–95.3), 100%, 98.4% (95% CI: 95.3–99.9), and 61.0% (95% CI: 47.7–74.3), respectively. In multivariable analysis, age (RR: 0.97; p < 0.001), PSA density ≥0.2 ng/mL2 (RR: 13.23; p < 0.001), and PSA ≥1.0 ng/mL after surgery (RR: 5.19; p = 0.016) were significantly predictive for receiving an invasive treatment. Conclusion: In comparison with other AS series with a general low-risk prostate cancer population, our study confirmed the promising survival outcomes for IPC patients, whereas discontinuation rates seem to be lower for IPC. Thus, IPC patients at low risk of progression may be good candidates for AS.

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Section: Introductionmentioning

confidence: 99%

Active Surveillance for Incidental (cT1a/b) Prostate Cancer: Long-Term Outcomes of the Prospective Noninterventional HAROW Study

Herden

Schwarte

Boedefeld³

et al. 2021

Urol Int

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“…In developed countries, AS has gained traction in recent years. In the United States, up to 75% of very low-risk cases are initially treated with AS [ 26 ]. In Sweden, use of AS is even greater, reaching 91% for very-low-risk and 74% for low-risk cases [ 27 ].…”

Section: Discussionmentioning

confidence: 99%

Knowledge, attitudes, and practices of active surveillance in prostate cancer among urologists: a real-life survey from Brazil

et al. 2022

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Background Active surveillance (AS) is the preferred treatment for patients with very low-and low-risk prostate cancer (PCa), but it is underperformed worldwide. This study aimed to report knowledge, attitudes, and practices (KAP) of AS for PCa among urologists in Brazil. Methods This cross-sectional study used a questionnaire with 50 questions divided into participant characteristics, knowledge regarding inclusion criteria for AS, follow-up, intervention triggers, acceptance, and practice for an index patient. Data analysis comprises absolute and relative frequencies of the variables. After that, a logistic regression was performed in order to verify possible patterns of answers provided by the respondents in the index patient questionnaire. Results Questionnaires were sent through the SurveyMonkey® platform to 5,015 urologists using email addresses and through social media. A total of 600 (12%) questionnaires returned and 413 (8.2%) were completed and included in the analysis. Only 53% of urologists adopt AS for low- and very-low-risk PCa. Inclusion criteria were patients with age > 50 years (32.2%), prostate specific antigen (PSA) < 10 ng/mL (87.2%), T1 clinical stage (80.4%), Biopsy Gleason score ≤ 6, positive cores ≤ 2 (44.3%), positive core involvement < 50% (45.3%), and magnetic resonance imaging findings (38.7%). The PSA doubling time was still used by 60.3%. Confirmatory biopsy (55.9%), PSA level (36.6%), and digital rectal examination (34.4%) were considered by most urologists for follow-ups. Patient preference (85.7%), upgrade of Gleason score (73.4%), and increased number of positive cores (66.8%) were associated with conversion to definitive treatment. In an index patient, non-acceptance and active treatment request were the most cited reasons for not performing AS. Conclusion There is significant variability in the KAP of AS in Brazil, which indicates the need to reinforce AS, its inclusion and follow-up criteria, and the benefits for physicians and the general population. Trial registration: Not applicable.

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Three-year Active Surveillance Outcomes in a Contemporary Community Urology Cohort in the United States

Shelton

Paivanas

Buffington

et al. 2019

Urology

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Contemporary Management of Incident Prostate Cancer in Large Community Urology Practices in the United States

Cited by 6 publications

References 23 publications

Active Surveillance for Incidental (cT1a/b) Prostate Cancer: Long-Term Outcomes of the Prospective Noninterventional HAROW Study

Active Surveillance for Incidental (cT1a/b) Prostate Cancer: Long-Term Outcomes of the Prospective Noninterventional HAROW Study

Knowledge, attitudes, and practices of active surveillance in prostate cancer among urologists: a real-life survey from Brazil

Three-year Active Surveillance Outcomes in a Contemporary Community Urology Cohort in the United States

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