Extended Followup and Risk Factors for Disease Reclassification in a Large Active Surveillance Cohort for Localized Prostate Cancer

Welty, Christopher J.; Cowan, Janet E.; Nguyen, Hao G.; Shinohara, Katsuto; Perez, Nannette; Greene, Kirsten L.; Chan, June M.; Meng, Maxwell V.; Simko, Jeffry P.; Cooperberg, Matthew R.; Carroll, Peter R.

doi:10.1016/j.juro.2014.09.094

Cited by 144 publications

(105 citation statements)

References 27 publications

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“…Of the remaining 22% of patients, no recent update (>1 year) was available, and these patients should be considered lost to follow-up with the possibility of actually still being on AS or in the meantime having discontinued AS. In other AS cohorts, higher rates of patients still being on AS are reported, with 50% to 63.5% after 10 years (17,18,27), possibly explained by differences in inclusion and followup criteria, and the less strictly controlled PRIAS protocol. Moreover, not all patients who switch to active treatment do so because of protocol based signs of progression.…”

Section: Discussionmentioning

confidence: 95%

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: Discussionmentioning

confidence: 95%

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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“…Tablo 2'de farklı merkezlerin uygulamış olduğu takip protokolleri özetlenmiştir (10,11,12,13,14,15,16,17,18). Genel olarak Aİ'den definitif tedaviye geçmedeki nedenler progresyon olmadığı halde hastanın tercihi veya hastada oluşturduğu anksiyete, başlangıçtaki yüksek veya izlemde yükselen PSA değerleri, başlangıçtaki veya tekrar biyopsilerde saptanan yüksek evre, Gleason skor veya korlardaki yüksek kanser oranıdır (23).…”

Section: Aktif İzlem Protokolleri Ve Progresyonu Belirten Kriterlerunclassified

“…Konfirmasyon biyopsisi sonrası hasta seçimine ve biyopsi tekniğine bağlı değişmekle birlikte %2,5-28 oranında Gleason derecesinde değişiklik bildirilmiştir (15). Takip biyopsilerinde ise farklı merkezlerde %22-30 oranında progresyon saptanmıştır (11,12,13).…”

Section: Biyopsiunclassified

Active Surveillance in Prostate Cancer

İzol¹,

Akdogan²

2017

uob

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“…At the University of California San Francisco, 810 men have been managed with AS based on quarterly PSA testing, repeat biopsy within 12 months, and follow-up biopsy every 1 to 2 years depending on medical risk. 34 Of these men, 69% met strict eligibility criteria of PSA ≤10 ng/ml, clinical stage T1/T2, Gleason score ≤6, ≤33% positive biopsy cores, and ≤50% involvement of any core with cancer. The authors reported a 5-year treatment-free survival of 60%, and there were no prostate cancer deaths during a median follow-up of 60 months.…”

Section: Outcomes Of Active Surveillancementioning

confidence: 99%

Active Surveillance of Prostate Cancer: Use, Outcomes, Imaging, and Diagnostic Tools

Tosoian¹,

Loeb²,

Epstein³

et al. 2016

American Society of Clinical Oncology Educational Book

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Active surveillance (AS) has emerged as a standard management option for men with very low-risk and low-risk prostate cancer, and contemporary data indicate that use of AS is increasing in the United States and abroad. In the favorable-risk population, reports from multiple prospective cohorts indicate a less than 1% likelihood of metastatic disease and prostate cancer-specific mortality over intermediate-term follow-up (median 5 to 6 years). Higher-risk men participating in AS appear to be at increased risk of adverse outcomes, but these populations have not been adequately studied to this point. Although monitoring on AS largely relies on serial prostate biopsy, a procedure associated with significant morbidity, there is a need for improved diagnostic tools for patient selection and monitoring. Revisions from the 2014 International Society of Urologic Pathology consensus conference have yielded a more intuitive reporting system and detailed reporting of low-intermediate grade tumors, which should facilitate the practice of AS. Meanwhile, emerging modalities such as multiparametric magnetic resonance imaging and tissue-based molecular testing have shown prognostic value in some populations. At this time, however, these instruments have not been sufficiently studied to consider their routine, standardized use in the AS setting. Future studies should seek to identify those platforms most informative in the AS population and propose a strategy by which promising diagnostic tools can be safely and efficiently incorporated into clinical practice.

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Extended Followup and Risk Factors for Disease Reclassification in a Large Active Surveillance Cohort for Localized Prostate Cancer

Cited by 144 publications

References 27 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

Active Surveillance in Prostate Cancer

Active Surveillance of Prostate Cancer: Use, Outcomes, Imaging, and Diagnostic Tools

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