Las respuestas y conveniencia de la vigilancia activa en cáncer de próstata (en respuesta al comentario editorial del Dr. Sánchez Badajoz)

Rubio‐Briones, J.; Borque‐Fernando, Ángel

doi:10.1016/j.acuro.2015.08.005

Cited by 5 publications

(1 citation statement)

References 18 publications

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“…The unavoidable consequences of over-detection in PCa are not synonymous of over-treatment because AS contributes to a responsible management of patients in low or very low grade and low volume PCa [ 23 ]. Nevertheless, still many urologists are reluctant to offer AS to their patients [ 24 ], arguing a lack of confidence in conservative management instead of an active treatment, and due to uncertainties with their general pathologists and radiologists with no specific training in mpMRI, or lack of strong evidence that new biomarkers could help in this setting [ 23 ]. Other non scientific reasons could be explained by the need to justify economical and technical investments to their health care providers.…”

Section: Discussionmentioning

confidence: 99%

The management of active surveillance in prostate cancer: validation of the Canary Prostate Active Surveillance Study risk calculator with the Spanish Urological Association Registry

et al. 2017

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The follow up of patients on active surveillance requires to repeat prostate biopsies. Predictive models that identify patients at low risk of progression or reclassification are essential to reduce the number of unnecessary biopsies. The aim of this study is to validate the Prostate Active Surveillance Study risk calculator (PASS-RC) in the multicentric Spanish Urological Association Registry of patients on active surveillance (AS), from common clinical practice.ResultsWe find significant differences in age, PSA and clinical stage between our validation cohort and the PASS-RC generation cohort (p < .0001), with a reclassification rate of 10–22% on the follow-up Bx, no cancer was found in 43% of the first follow-up Bx. The calibration curve shows underestimation of real appearance of reclassification. The AUC is 0.65 (C.I.95%: 0.60–0.71). PDF and CUC do not suggest a specific cut-off point of clinical use.MethodsWe select 498 patients on AS with a minimum of one follow-up biopsy (Bx) from the 1,024 males registered by 36 Spanish centers recruiting patients on the Spanish Urological Association Registry on AS. PASS-RC external validation is carried by means of calibration curve and area under de ROC-curve (AUC), identifying cut-offs of clinical utility by probability density functions (PDF) and clinical utility curves (CUC).ConclusionsIn our first external validation of the PASS-RC we have obtained a moderate discrimination ability, although we cannot recommend cut-off points of clinical use. We suggest the exploration of new biomarkers and/or morpho-functional parameters from multiparametric magnetic resonance image, to improve those necessary tools on AS.

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Section: Discussionmentioning

confidence: 99%