The Relationship Between Anxiety and Time to Treatment for Patients With Prostate Cancer on Surveillance

Latini, David; Hart, Stacey L.; Knight, Sara J.; Cowan, Janet E.; Ross, Paul; DuChane, Janeen; Carroll, Peter R.; Investigators, CaPSURETM

doi:10.1016/j.juro.2007.05.039

Cited by 196 publications

(160 citation statements)

References 19 publications

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“…Furthermore, plotting a reference range over time, as in Figure 1, shows the increase in PSA level expected with advancing age in a healthy man. This may provide reassurance, as what might be a worrying trend upwards is shown to be consistent with the expected age-related increases for a healthy man of similar age and starting PSA level (Latini et al, 2007;Pickles et al, 2007).…”

Section: Discussionsupporting

confidence: 56%

Current strategies for monitoring men with localised prostate cancer lack a strong evidence base: observational longitudinal study

et al. 2009

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BACKGROUND: The UK National Institute for Health and Clinical Excellence (NICE) guidance recommends conservative management of men with 'low-risk' localised prostate cancer, monitoring the disease using prostate-specific antigen (PSA) kinetics and re-biopsy. However, there is little evidence of the changes in PSA level that should alert to the need for clinical re-assessment. METHODS: This study compares the alerts resulting from PSA kinetics and a novel longitudinal reference range approach, which incorporates age-related changes, during the monitoring of 408 men with localised prostate cancer. Men were monitored by regular PSA tests over a mean of 2.9 years, recording when a man's PSA doubling time fell below 2 years, PSA velocity exceeded 2 ng ml -1 per year, or when his upper 10% reference range was exceeded. RESULTS: Prostate-specific antigen doubling time and PSA velocity alerted a high proportion of men initially but became unresponsive to changes with successive tests. Calculating doubling time using recent PSA measurements reduced the decline in response. The reference range method maintained responsiveness to changes in PSA level throughout the monitoring. CONCLUSION: The increasing unresponsiveness of PSA kinetics is a consequence of the underlying regression model. Novel methods are needed for evaluation in cohorts currently being managed by monitoring. Meanwhile, the NICE guidance should be cautious.

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Section: Discussionsupporting

confidence: 56%

Current strategies for monitoring men with localised prostate cancer lack a strong evidence base: observational longitudinal study

et al. 2009

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“…However, patients' anxiety is often a clinical obstacle for such treatments. 15 Focal therapy has been introduced as an alternative bridging radical and deferred therapeutical options. Partial organ ablation can be offered for patients with insignificant cancer to preserve the non-malignant part of the prostate gland and minimize any functional side effects.…”

Section: Discussionmentioning

confidence: 99%

Parameters predicting postoperative unilateral disease in patients with unilateral prostate cancer in diagnostic biopsy: a rationale for selecting hemiablative focal therapy candidates

Sfoungaristos

Perimenis

2013

CUAJ

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E82Cite as: Can Urol Assoc J 2013;7:E82-E87. http://dx.doi.org/10.5489/cuaj.268. Epub 2011 November 2. AbstractBackground: Focal hemiablative therapy for prostate cancer is a new treatment alternative. Unilateral and unifocal disease are its main limitations. The aim of this study was to identify the epidemiological, clinical and pathological parameters that may predict unilateral disease in patients diagnosed with prostate cancer. Methods:We performed a retrospective analysis of patients at our institution between January 2005 and January 2011. Only patients with unilateral disease in prostate biopsy were part of the study. The analysis included age, preoperative prostate-specific antigen (PSA) and its density, prostate volume, biopsy first and second Gleason pattern and Gleason summary, number of biopsy cores, percentage of cancer in biopsy material and the presence of highgrade prostatic intraepithelial neoplasia. Their role as potential predictors was evaluated by univariate and multivariate analysis. Results: A total of 161 patients had unilateral disease after prostate biopsy. A significant correlation was found between prostate volume, PSA density and percentage of cancer in biopsy material and the presence of unilateral disease in the surgical specimen. These are the same factors significant in the univariate analysis. The results of the multivariate analysis demonstrated that PSA density (p = 0.015) and percentage of cancer in biopsy material (p = 0.028) are the most significant predictors. Interpretation: Our results demonstrate that PSA density and the percentage of cancer in biopsy cores are significant predictors for prostate cancer unilaterality and should be considered for the selection of hemiablative focal therapy candidates.

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“…Psychological factors might influence decisions on receiving treatment in men with expectantly managed prostate cancer [18]. The main reason for stopping AS in our cohort was protocol-based and not due to psychological factors.…”

Section: A N D E N B E R G H E T a Lmentioning

confidence: 92%

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 Relationship Between Anxiety and Time to Treatment for Patients With Prostate Cancer on Surveillance

Cited by 196 publications

References 19 publications

Current strategies for monitoring men with localised prostate cancer lack a strong evidence base: observational longitudinal study

Current strategies for monitoring men with localised prostate cancer lack a strong evidence base: observational longitudinal study

Parameters predicting postoperative unilateral disease in patients with unilateral prostate cancer in diagnostic biopsy: a rationale for selecting hemiablative focal therapy candidates

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

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