Oncologic Outcomes of Definitive Treatments for Low- and Intermediate-Risk Prostate Cancer After a Period of Active Surveillance

Whalen, Michael J.; Pak, Jamie S.; Lascano, Danny; Ahlborn, David; Matulay, Justin T.; McKiernan, James M.; Benson, Mitchell C.; Wenske, Sven

doi:10.1016/j.clgc.2017.10.007

Cited by 8 publications

(11 citation statements)

References 23 publications

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“…In spite of the reassuring survival outcomes, the definitive treatment rate was higher than that published in previous reports with rates historically varying from 29 to 61%. (7,11,(16)(17)(18)(19) One of the possible explanations for our higher rates, in addition to longer follow-up when compared to previous publications, is the fact our study only included men that were considered as intermediate-risk PCa based solely on their GGG and not on their PSA level or digital rectal exam. In comparison, in the previously reported studies of men with intermediate-risk PCa managed by AS, the proportion of men included with GGG2 and 3 PCa varied from 22% to 63%.…”

Section: Discussionmentioning

confidence: 95%

“…These studies have reported cancer-specific mortality rates for men with intermediate-risk PCa managed by AS varying from 0% to 4% after a follow-up ranging from 28 to 80 months. (7,11,(16)(17)(18)(19) evidence suggests that, at the very least, a subset of GGG2 and 3 PCa patients could be managed with AS while avoiding some of the potential complications associated with PCa treatments.…”

Section: Discussionmentioning

confidence: 99%

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The long-term outcomes of Gleason grade groups 2 and 3 prostate cancer managed by active surveillance: Results from a large population-based cohort

Richard

Timilshina²,

Komisarenko³

et al. 2020

CUAJ

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Introduction: Active surveillance (AS) is an accepted management strategy for low-risk prostate cancer (PCa), but its role in the management of favorable intermediate-risk PCa remains controversial. Most reports studying the role of AS for these men generally lack long-term followup and include small numbers of patients. Our objective was to report the outcomes of men diagnosed with Gleason grade groups (GGG) 2 and 3 PCa who were managed expectantly. Methods: Using administrative datasets and pathology reports, we identified all men who were diagnosed with GGG 2 and 3 PCa and managed expectantly between 2002 and 2011 in Ontario, Canada. Outcomes and associated factors were estimated using cumulative incidence function methods and multivariable Cox regression models, respectively. Results: We identified 926 men who were managed expectantly (AS [n=374] or watchful waiting [n=552]). The eight-year cancer-specific survival was 94% and 89% for the AS and watchful waiting cohorts, respectively. Among AS men, 266 (71%) received treatment after a followup of approximately eight years. Cumulative AS discontinuation rates at one and five years were 30.5% and 65.1%, respectively. Conclusions: Expectant management of GGG 2 and 3 PCa may be an option for certain men. Notably for AS patients, the cancer-specific mortality at eight years was 6%, and over 65% of men underwent treatment within five years. Further studies are required to evaluate which patients, based on disease-specific features and competing health risks, would benefit the most from a conservative strategy.

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Section: Discussionmentioning

confidence: 95%

Section: Discussionmentioning

confidence: 99%

The long-term outcomes of Gleason grade groups 2 and 3 prostate cancer managed by active surveillance: Results from a large population-based cohort

Richard

Timilshina²,

Komisarenko³

et al. 2020

CUAJ

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“…However, in this study, the outcome in patients who underwent external beam radiotherapy (EBRT) after initial AS were not as favourable with 24% experiencing biochemical recurrence (BCR). Two other studies 3 , 4 showed equally poor results In the so far largest study on EBRT after AS, Berlin et al…”

Section: Introductionmentioning

confidence: 90%

“…In the Johns Hopkins cohort of 96 patients treated with EBRT, 15% experienced BCR 3 after a median follow-up of 2.8 years after treatment. In a more recent publication, the 10-year BCR rate (n=45) after EBRT was 47% compared with 25% for radical RP (n=27) 4 . In the single center study by Berlin et al 5 of 215 patients, they found that the BCR rate was not different between patients who were treated immediately compared to patients on AS .…”

confidence: 96%

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Active surveillance before radiotherapy — outcome and predictive factors for multiple biopsies before treatment

Alcaidinho

Delouya

Bahary

et al. 2020

CUAJ

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Introduction: We aimed to investigate whether patients on active surveillance (AS) had worse outcomes than patients who received immediate treatment with radiotherapy and whether a Gleason grade progression on repeat biopsy influenced outcome. Methods: From our institutional database, we identified 2001 patients treated between 2005 and 2019 with primary external beam radiation therapy or brachytherapy. Biochemical recurrence (BCR) was analyzed in relation to clinical factors such as a Gleason grade progression or having multiple biopsies vs. only one biopsy. Patients on AS were identified as those who had undergone ≥2 biopsies. We used log-rank tests for univariate analysis (UVA) and Cox regression analysis for multivariable analysis (MVA). Results: Of 2001 patients, 374 (19%) patients had ≥2 biopsies before treatment, of which 48% presented with a Gleason grade progression of mostly to Gleason 3+4 (36%); 32% had a cancer volume increase on biopsy and 16% had no significant change on biopsy. For patients with ≥2 biopsies, median time from first biopsy to treatment was 22.0 months (interquartile range [IQR] 14.7–36.1). By UVA, patients with Gleason grade progression (n=105) had a worse BCR-free rate (p=0.02) than patients who had no grade progression on repeat biopsy or only one biopsy. On MVA, this effect was lost. Having ≥2 biopsies was not a significant negative prognostic factor on UVA (p=0.2) or MVA. Conclusions: In our experience, radiotherapy after a period of AS, even with Gleason grade progression, did not lead to worse outcomes compared to patients who had radiotherapy after only one biopsy.

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Prevalence and Types of Genital Lesions in Organ Transplant Recipients

et al. 2018

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IMPORTANCE Squamous cell carcinoma (SCC) is the most common skin cancer diagnosed in solid organ transplant recipients (OTRs) and confers significant mortality. The development of SCC in the genital region is elevated in nonwhite OTRs. Viral induction, specifically human papillomavirus (HPV), is hypothesized to play a role in the pathophysiology of these lesions. OBJECTIVE To assess the prevalence and types of genital lesions observed in OTRs. DESIGN, SETTING, AND PARTICIPANTS This retrospective review included 496 OTRs who underwent full skin examination from November 1, 2011, to April 28, 2017, at an academic referral center. The review was divided into 2 distinct periods before a change in clinical management that took effect on February 1, 2016 (era 1) and after that change (era 2). Patient awareness of genital lesions was assessed. All lesions clinically suggestive of malignant tumors were biopsied and underwent HPV polymerase chain reaction typing. MAIN OUTCOMES AND MEASURES Number and types of genital lesions, proportion of malignant tumors positive for HPV, and patients cognizant of genital lesions. RESULTS Of the total 496 OTRs, 376 OTRs were evaluated during era 1 (mean [SD] age, 60 years; age range, 32-94 years; 45 [65.2%] male; 164 [43.6%] white) and 120 OTRs were evaluated during era 2 of the study (mean age, 56 years; age range, 22-79 years; 76 [63.3%] male; 30 [25.0%] white). Overall, 111 of the 120 OTRs (92.5%) denied the presence of genital lesions during the history-taking portion of the medical examination. Genital lesions were found in 53 OTRs (44.2%), cutaneous malignant tumors (basal cell carcinoma and SCC in situ) in 6 (5.0%), genital SCC in situ in 3 (4.2%), and condyloma in 29 (24.2%). Eight of the 12 SCC in situ lesions (66.7%) were positive for high-risk HPV. Seven tested positive for HPV-16 and HPV-18, and 1 tested positive for high-risk HPV DNA but could not be further specified. CONCLUSIONS AND RELEVANCE Genital lesions in OTRs are common, but awareness is low. All OTRs should undergo thorough inspection of genital skin as a part of routine posttransplant skin examinations. Patients with darker skin types are disproportionately affected by cutaneous genital malignant tumors and should undergo a targeted program of early detection, prevention, and awareness focused on the risk of genital skin cancer after transplant. High-risk HPV subtypes are associated with genital SCC in OTRs. Additional studies are warranted to identify significant risk factors for HPV infection and to assess the utility of pretransplant HPV vaccination in the prevention of cutaneous genital malignant tumors.

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Oncologic Outcomes of Definitive Treatments for Low- and Intermediate-Risk Prostate Cancer After a Period of Active Surveillance

Cited by 8 publications

References 23 publications

The long-term outcomes of Gleason grade groups 2 and 3 prostate cancer managed by active surveillance: Results from a large population-based cohort

The long-term outcomes of Gleason grade groups 2 and 3 prostate cancer managed by active surveillance: Results from a large population-based cohort

Active surveillance before radiotherapy — outcome and predictive factors for multiple biopsies before treatment

Prevalence and Types of Genital Lesions in Organ Transplant Recipients

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