Outcomes Following Active Surveillance of Men With Localized Prostate Cancer Diagnosed in the Prostate Specific Antigen Era

Ercole, Barbara; Marietti, Sarah; Fine, Jacob; Albertsen, Peter C.

doi:10.1016/j.juro.2008.06.027

Cited by 42 publications

(58 citation statements)

References 16 publications

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“…Eight non-comparative studies of low-risk patients undergoing active surveillance reported prostate cancer survival rates of 100% [5][6][7][8][9][10][11][12] and another two non-comparative studies reported high prostate cancer survival rates of 97% 13 98%, respectively. 14 Studies comparing immediate RP with delayed RP in patients undergoing AS detected no significant differences in biochemical recurrence rate, positive surgical margins, extraprostatic extension, [15][16][17] and risk of incurable cancer.…”

Section: Recommendationmentioning

confidence: 99%

“…[5][6][7][8][9][12][13][14][15][16][18][19][20][21][22]29,32,33 The studies reporting their active surveillance protocol conducted multicore (6-to 17-core) biopsies every 1 to 2 years. 5,10,12,[15][16][17][18]21,23,[28][29][30][33][34][35] Five studies conducted multicore biopsies every 2 to 4 years. 8,11,13,19,32 Regarding Multiparametric MRI, it has been shown to be a good predictor of disease reclassification.…”

Section: Recommendationmentioning

confidence: 99%

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Active surveillance for the management of localized prostate cancer: Guideline recommendations

Morash

Tey

Agbassi

et al. 2015

CUAJ

197

131

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Introduction: The objective is to provide guidance on the role of active surveillance (AS) as a management strategy for low-risk prostate cancer patients and to ensure that AS is offered to appropriate patients assessed by a standardized protocol. Prostate cancer is often a slowly progressive or sometimes non-progressive indolent disease diagnosed at an early stage with localized tumours that are unlikely to cause morbidity or death. Standard active treatments for prostate cancer include radiotherapy (RT) or radical prostatectomy (RP), but the harms from over diagnosis and overtreatment are of a significant concern. AS is increasingly being considered as a management strategy to avoid or delay the potential harms caused by unnecessary radical treatment. Methods: A literature search of MEDLINE, EMBASE, the Cochrane library, guideline databases and relevant meeting proceedings was performed and a systematic review of identified evidence was synthesized to make recommendations relating to the role of AS in the management of localized prostate cancer. Results: No exiting guidelines or reviews were suitable for use in the synthesis of evidence for the recommendations, but 59 reports of primary studies were identified. Due to studies being either non-comparative or heterogeneous, pooled meta-analyses were not conducted. Conclusion:The working group concluded that for patients with low-risk (Gleason score ≤6) localized prostate cancer, AS is the preferred disease management strategy. Active treatment (RP or RT) is appropriate for patients with intermediate-risk (Gleason score 7) localized prostate cancer. For select patients with low-volume Gleason 3+4=7 localized prostate cancer, AS can be considered.

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Section: Recommendationmentioning

confidence: 99%

Section: Recommendationmentioning

confidence: 99%

Active surveillance for the management of localized prostate cancer: Guideline recommendations

Morash

Tey

Agbassi

et al. 2015

CUAJ

197

131

View full text Add to dashboard Cite

show abstract

“…AS programmes have been initiated to acquire evidence for the currently used selection and surveillance criteria, which are based on retrospective data [6][7][8][9][10][11]. The 'Prostate Cancer Research International: Active Surveillance (PRIAS) study [12] is an international prospective observational study originating from the European Randomized Study of Screening for Prostate Cancer (ERSPC) [13].…”

Section: Introductionmentioning

confidence: 99%

Short‐term outcomes of the prospective multicentre ‘Prostate Cancer Research International: Active Surveillance’ study

et al. 2010

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a Gleason score of ≤ 3 + 3 = 6, and one or two positive biopsy cores, were analysed. The follow-up protocol consisted of frequent PSA measurements, digital rectal examinations, and standard repeat biopsies (the first after 1 year). The primary outcome is survival free of active therapy; the secondary endpoints are reasons for stopping AS, findings in 1-year repeat biopsies, and outcomes after radical prostatectomy (RP). RESULTSPatients were included between December 2006 and July 2008. The median (25-75th percentile) follow-up after diagnosis was 1.02 (0.6-1.5) years. The 2-year survival rate free from active therapy was 73%. Of the 82 men who changed to active therapy during the follow-up, 68 (83%) did so based on the protocol. Of the 261 repeat biopsies available for analysis, 90 (34%) showed no cancer, while 57 (22%) showed a Gleason score of > 6 or more than two positive biopsy cores. There was a relatively unfavourable PSA doubling time of 0-10 years in 53% (102/194) and 62% (33/53) of men with favourable and unfavourable re-biopsy results, respectively. After RP, four of 24 (17%) men had T3 disease and 12 (50%) had a Gleason score of > 6. CONCLUSIONAS seems feasible, but mortality outcomes are unknown. A strict follow-up protocol including standard 1-year repeat biopsies resulted in a quarter of men stopping AS after 2 years.

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“…The prostate cancer is the most common malign visceral neoplasia in men and the incidence tends to increase in coming decades with the increase in life expectancy (14,24,37) . Approximately 543 thousand new cases are diagnosed each year worldwide.…”

Section: Introductionmentioning

confidence: 99%

“…Histological and serological exams describe very important aspects, allowing the monitoring of the disease evolution (3,16) . However, the immuno-histochemical methods as discussed in qualitative form have shown great disparity and variability of results among different observers (13,14,30) . In order to provide a numerical scale and reproducible patterns of marking tissue, increasing the sensitivity and quality control analysis, it has sought increasingly technological refinements using automated morphometric methods (12) .…”

Section: Introductionmentioning

confidence: 99%

Utility of tissue microarrays MIB-1 for profiling prognostic biomarkers in clinically localized prostate cancer

Nassif¹,

Filho²,

Paula³

2009

J. Bras. Patol. Med. Lab.

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10 ng/dl) (p = 0.010), higher Gleason score (> 7) (p = 0.0003) and pathological stage pT2c (p = 0.001). In the comparison of variables, it was noticed that patients with positive expression had a higher mean PSA (p = 0.031), higher Gleason score (p < 0.0001), longer follow-up (p = 0.037), larger area of vascular proliferation (p < 0.0001) and higher proportion of tumor in relation to normal area (p = 0.012). CONCLUSION: MIB-1 proved to be a prognostic factor comparable to PSA, Gleason and staging.]]>

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Outcomes Following Active Surveillance of Men With Localized Prostate Cancer Diagnosed in the Prostate Specific Antigen Era

Abstract: Men with low grade prostate cancer can elect active surveillance and have excellent long-term results.

Cited by 42 publications

References 16 publications

Active surveillance for the management of localized prostate cancer: Guideline recommendations

Active surveillance for the management of localized prostate cancer: Guideline recommendations

Short‐term outcomes of the prospective multicentre ‘Prostate Cancer Research International: Active Surveillance’ study

Utility of tissue microarrays MIB-1 for profiling prognostic biomarkers in clinically localized prostate cancer

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