Factors Associated with Time to Conversion from Active Surveillance to Treatment for Prostate Cancer in a Multi-Institutional Cohort

Cooley, Lauren Folgosa; Emeka, Adaeze A.; Meyers, Travis J.; Cooper, Phillip R.; Lin, Daniel W.; Finelli, Antonio; Eastham, James A.; Logothetis, Christopher J.; Marks, Leonard S.; Vesprini, Danny; Goldenberg, S. Larry; Higano, Celestia S.; Pavlovich, Christian P.; Chan, June M.; Morgan, Todd M.; Klein, Eric A.; Barocas, Daniel A.; Loeb, Stacy; Helfand, Brian T.; Scholtens, Denise M.; Witte, John S.; Catàlona, William J.

doi:10.1097/ju.0000000000001937

Cited by 18 publications

(16 citation statements)

References 30 publications

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“…Of these, scrutinising against the selection criteria, 591 studies were excluded after reading the title or abstract, and 34 studies were excluded after full-text review. Ultimately, 25 studies were included in the systematic review [ 11 , 14 , 15 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 ].…”

Section: Resultsmentioning

confidence: 99%

Comparison of Outcomes of Active Surveillance in Intermediate-Risk Versus Low-Risk Localised Prostate Cancer Patients: A Systematic Review and Meta-Analysis

Mukherjee

Papadopoulos

Norris

et al. 2023

JCM

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Currently, there is no clear consensus regarding the role of active surveillance (AS) in the management of intermediate-risk prostate cancer (IRPC) patients. We aim to analyse data from the available literature on the outcomes of AS in the management of IRPC patients and compare them with low-risk prostate cancer (LRPC) patients. A comprehensive literature search was performed, and relevant data were extracted. Our primary outcome was treatment-free survival, and secondary outcomes were metastasis-free survival, cancer-specific survival, and overall survival. The DerSimonian–Laird random-effects method was used for the meta-analysis. Out of 712 studies identified following an initial search, 25 studies were included in the systematic review. We found that both IRPC and LRPC patients had nearly similar 5, 10, and 15 year treatment-free survival rate, 5 and 10 year metastasis-free survival rate, and 5 year overall survival rate. However, cancer-specific survival rates at 5, 10, and 15 years were significantly lower in IRPC compared to LRPC group. Furthermore, IRPC patients had significantly inferior long-term overall survival rate (10 and 15 year) and metastasis-free survival rate (15 year) compared to LRPC patients. Both the clinicians and the patients can consider this information during the informed decision-making process before choosing AS.

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Section: Resultsmentioning

confidence: 99%

Comparison of Outcomes of Active Surveillance in Intermediate-Risk Versus Low-Risk Localised Prostate Cancer Patients: A Systematic Review and Meta-Analysis

Mukherjee

Papadopoulos

Norris

et al. 2023

JCM

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“…In detail, the confirmatory biopsy within one year from diagnosis upgrade the highest number of patients; in particular, the transperineal template biopsy upgrade about 38.0% of patients (16). A lot of studies reported on criteria of patient selection and follow up policies of men enrolled in AS protocol: type and timing of imaging, frequency of repeat prostate biopsies, use of PSA density and kinetics, genetics biomarkers, use risk calculators, and frequency of clinical follow-up (17)(18)(19)(20)(21)(22)(23). Although mpMRI is strongly recommended in patients enrolled in AS protocols (24), at present, systematic prostate biopsies should be always combined with targeted fusion biopsy due to the false negative rate of mpMRI (25)(26)(27); moreover, the number of targeted-fusion biopsy (in the presence of PI-RADS ≥ 3) that should be obtained in addition to systematic prostate biopsy in men enrolled in AS protocols (8) has not been established (28).…”

Section: Discussionmentioning

confidence: 99%

Conﬁrmatory transperineal saturation prostate biopsy combined with mpMRI decrease the reclassiﬁcation rate in men enrolled in Active Surveillance: Our experience in 100 men submitted to eight-years scheduled biopsy

Pepe

Pennisi

et al. 2022

Arch Ital Urol Androl

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Introduction: The reclassiﬁcation rate for clinically signiﬁcant prostate cancer (csPCa) in men enrolled in Active Surveillance (AS) as been prospective-ly evaluated. Patients and methods: One hundred patients with very low risk PCa underwent after 8 years a scheduled transperineal prostate biopsy (SPBx = 20 cores) combined with additionalmpMRI/TRUS fusion biopsies (4 cores) of lesions PI-RADS scores ≥ 3. All the patients, after initial diagnosis, previously had mpMRI evaluation combined with transperineal saturation prostate biopsy (conﬁrmatory and 3-year scheduled biopsy). Risk reclassiﬁcation at repeat biopsy triggering the recommen-dation for active treatment was deﬁned as over 3 or more than 10% of positive cores, Gleason score > 6/ISUP Grade Group ≥ 2, greatest percentage of cancer (GPC) > 50%.Results: Multiparametric MRI was suspicious (PI-RADS ≥ 3) in 30 of 100 cases (30.0%); 70 (70.0%) vs. 20 (20.0%) vs. 10(10.0%) patients had a PI-RADS score ≤ 2 vs. 3 vs. 4, respec-tively. Two (2.0%) patients with PI-RADS score 3 and 4 were upgraded (ISUP Grade Group 2); SPBx and MRI/TRUS fusion biopsy diagnosed 100% and 0% of csPCa, respectively. Conclusions: Transperineal SPBx combined with mpMRI at ini-tial conﬁrmatory biopsy allow to select an high number of men at very low risk of reclassiﬁcation during the AS follow up (2.0%of the cases at 8 years from diagnosis); these data could be use-ful to reduce the number of scheduled repeated prostate biopsy during the AS follow up.

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“…A study including 6775 ( n = 1288 with intermediate-risk) men on AS evaluated the factors related to conversion to active treatment [ 24 ]. With a median follow-up of 6.7 years, 2260 (33.4%) patients converted to active treatment.…”

Section: Risk Stratification Of Intermediate-risk Pc In Asmentioning

confidence: 99%

“…Many cohorts have included men with intermediate-risk under AS [ 14 , 24 , 25 , 63 , 64 , 65 , 66 , 67 , 68 , 69 , 70 , 71 , 72 , 73 , 74 , 75 , 76 , 77 , 78 , 79 ]. Table 2 shows a summary of studies including intermediate-risk patients undergoing AS and compares oncological outcomes between low-risk and intermediate-risk.…”

Section: Criteria For Inclusion Monitoring and Trigger For Interventionmentioning

confidence: 99%

Active Surveillance in Intermediate-Risk Prostate Cancer: A Review of the Current Data

Blas

Shiota

Eto

2022

Cancers

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Active surveillance (AS) is a monitoring strategy to avoid or defer curative treatment, minimizing the side effects of radiotherapy and prostatectomy without compromising survival. AS in intermediate-risk prostate cancer (PC) has increasingly become used. There is heterogeneity in intermediate-risk PC patients. Some of them have an aggressive clinical course and require active treatment, while others have indolent disease and may benefit from AS. However, intermediate-risk patients have an increased risk of metastasis, and the proper way to select the best candidates for AS is unknown. In addition, there are several differences between AS protocols in inclusion criteria, monitoring follow-up, and triggers for active treatment. A few large series and randomized trials are under investigation. Therefore, more research is needed to establish an optimal therapeutic strategy for patients with intermediate-risk disease. This study summarizes the current data on patients with intermediate-risk PC under AS, recent findings, and discusses future directions.

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Factors Associated with Time to Conversion from Active Surveillance to Treatment for Prostate Cancer in a Multi-Institutional Cohort

Abstract: intermediate and high-risk tumors. An exploratory analysis of self-reported race and genetic ancestry revealed no association with the time to conversion.

Cited by 18 publications

References 30 publications

Comparison of Outcomes of Active Surveillance in Intermediate-Risk Versus Low-Risk Localised Prostate Cancer Patients: A Systematic Review and Meta-Analysis

Comparison of Outcomes of Active Surveillance in Intermediate-Risk Versus Low-Risk Localised Prostate Cancer Patients: A Systematic Review and Meta-Analysis

Conﬁrmatory transperineal saturation prostate biopsy combined with mpMRI decrease the reclassiﬁcation rate in men enrolled in Active Surveillance: Our experience in 100 men submitted to eight-years scheduled biopsy

Active Surveillance in Intermediate-Risk Prostate Cancer: A Review of the Current Data

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