Outcomes and Implications of Follow-Up Biopsies of Men on Active Surveillance for Low-Risk Prostate Cancer

Smith, Angela; Coward, Matthew; Doak, Hoyt; Kurpad, Raj; Nix, Jeff; Nielsen, Matthew; Schultz, Heather; Wallen, Eric; Pruthi, Raj S.

doi:10.1016/s0022-5347(09)61708-0

Cited by 2 publications

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“…Some showed a significant relationship between age with PSA evolution, biopsy reclassification, disease progression and risk of all-cause versus prostate cancer mortality (12, 13, 17, 19–23). Meanwhile, others found age not to be a significant contributor (5, 8, 9, 14–18, 24–35). Fleshner et al (13) reported that the relative risk of pathological progression (GS>6, >4 cores positive, or >50% core involvement) and disease progression (defined as treatment initiation) increased with higher age, higher baseline PSA, lower baseline prostate volume, and positive family history.…”

Section: Evidence Synthesismentioning

confidence: 98%

“…However, in other studies race was not a significant predictor of surveillance biopsy outcome or conversion to active treatment (10, 13–18). For example, Smith and colleagues (14) investigated in a small study (n=71) the predictive value of race, baseline PSA, baseline grade, stage, age, and core length for positive second biopsy (cancer found), and the only significant variable was initial cancer core length.…”

Section: Evidence Synthesismentioning

confidence: 99%

“…The extent of cancer on biopsy such as number of positive cores, cancer length and/or percentage of core involvement were also shown in the majority of studies to be important predictors of disease progression or the probability of remaining on AS (5, 9, 11, 14, 19, 21, 24, 25, 27, 32, 35, 40, 45–47). Bul et al (19) showed that the strongest predictors for short-term biopsy reclassification (> 2 positive cores or GS >6 at repeat biopsy) were PSA density and the number of positive cores (2 versus 1).…”

Section: Evidence Synthesismentioning

confidence: 99%

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Active Surveillance for Prostate Cancer: A Systematic Review of Clinicopathologic Variables and Biomarkers for Risk Stratification

et al. 2015

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CONTEXT Active surveillance (AS) is an important strategy to reduce prostate cancer overtreatment. However, the optimal criteria for eligibility and predictors of progression while on AS are debated. OBJECTIVE To review primary data on markers, genetic factors and risk stratification for patient selection and predictors of progression during AS. EVIDENCE ACQUISITION Electronic searches were conducted in PubMed, Embase and CENTRAL from inception to April 2014 for original articles on biomarkers and risk stratification for AS. EVIDENCE SYNTHESIS Patient factors associated with AS outcomes in some studies include age, race, and family history. Multiple studies provide consistent evidence that lower percent free PSA, higher Prostate Health Index (phi), higher PSA density and greater biopsy core involvement at baseline predict a greater risk of progression. During follow-up, serial measurements of phi, PSA density, and repeat biopsy results predict later biopsy progression. While some studies have suggested a univariate relationship between urinary PCA3 and TMPRSS2:ERG with adverse biopsy features, these markers have not been consistently shown to independently predict AS outcomes. At this point, there is no conclusive data to support the use of genetic tests in AS Limitations of these studies include heterogeneous definitions of progression and limited follow-up. CONCLUSIONS There is a growing body of literature on patient characteristics, biopsy features, and biomarkers with potential utility in AS. More data are needed on practical applications such as combining these tests into multivariable clinical algorithms and long term outcomes, to further improve AS in the future. PATIENT SUMMARY Several PSA-based tests (free PSA, Prostate Health Index, PSA density) and the extent of cancer on biopsy can help to stratify the risk of progression during AS. Investigation into several other markers is underway.

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Section: Evidence Synthesismentioning

confidence: 98%

Section: Evidence Synthesismentioning

confidence: 99%

Section: Evidence Synthesismentioning

confidence: 99%

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Active Surveillance for Prostate Cancer: A Systematic Review of Clinicopathologic Variables and Biomarkers for Risk Stratification

et al. 2015

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“…Van der Bergh та співавтори [41] повідо мили, що у хворих на РПЗ з GS=7, у яких були в наявності інші основні критерії АС (PSA 10; PSAD<0,2; Т1с-Т2 стадії захворювання та 2 позитивних стовпчиків мала місце краща 6 річна виживаність без лікування у порівнянні з хворими на РПЗ та GS=7, у яких були відсутніми вказані критерії (100% проти 34% відповідно). Прогресія пухлини при пункційній біопсії (що прояв ляється у вигляді збільшення числа та довжини позитив них стовпчиків, відсотка залучення стовпчиків) також виз нана більшістю дослідників в якості важливого фактору несприятливого прогнозу захворювання та неможливості збереження хворих у групі АС [5,9,11,14,19 Active surveillance of patients with prostate cancer (Literature review)…”

Section: біопсійні факториunclassified

Active surveillance of patients with prostate cancer (Literature review)

Головко¹

2016

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Active surveillance (AS) is an important strategy that avoids overtreatment of prostate cancer (PCa). However, the optimal criteria for the possibility of continuing the Academy of Sciences or the factors of disease progression and the need to move to the beginning of the treatment are still contradictory. We have analyzed the primary data on risk factors as predictors of progression of prostate cancer in patients group AN: the patient's age at the Academy of Sciences, race, family history. In practical application can be a combination of some data, such as multivariate clinical algorithm and prediction of long-term results of the Academy of Sciences and to further improve the implementation of these predictors of the future.

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Outcomes and Implications of Follow-Up Biopsies of Men on Active Surveillance for Low-Risk Prostate Cancer

Cited by 2 publications

References 0 publications

Active Surveillance for Prostate Cancer: A Systematic Review of Clinicopathologic Variables and Biomarkers for Risk Stratification

Active Surveillance for Prostate Cancer: A Systematic Review of Clinicopathologic Variables and Biomarkers for Risk Stratification

Active surveillance of patients with prostate cancer (Literature review)

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