Purpose: We evaluated the risk of prostate cancer reclassification by time on active surveillance.Materials and Methods: From 1995 to 2014 we evaluated 557 and 251 men at very low and at low risk, respectively, who were on active surveillance and compliant with prostate biopsies. Our primary study outcome was reclassification to higher risk disease by grade or extent. Freedom from reclassification was estimated using the Kaplan-Meier approach with adjustment for covariates using the Cox proportional hazards model.Results: Within the first 2 years of surveillance patient survival free of reclassification by grade (p = 0.20) and by any biopsy criteria (p = 0.25) was similar in men with very low and low risk disease. After 2 years men with low risk disease were 2.4 times more likely to be diagnosed with a Gleason score of greater than 6 than men with very low risk disease (p = 0.002, HR 2.4, 95% CI 1.9–3.5). Additionally, beyond 2 years on surveillance the risk of lifetime reclassification by grade and by an...
Background Understanding the experiences of men leaving active surveillance programs is critical to making such programs viable for men with localized prostate cancer.
#1Jeffrey J. Tosoian(JHUSOM: Johns Hopkins University School of Medicine)H-Index: 29
#2Eric A. JohnBull(JHUSOM: Johns Hopkins University School of Medicine)H-Index: 4
Last. H. Ballentine Carter(JHUSOM: Johns Hopkins University School of Medicine)H-Index: 79
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Purpose: We assessed oncologic outcomes at surgery in men with low risk and very low risk prostate cancer who were candidates for active surveillance.Materials and Methods: In a prospectively collected institutional database, we identified 7,486 subjects eligible for active surveillance who underwent radical retropubic prostatectomy. Candidates were designated as being at low risk (stage T1c/T2a, prostate specific antigen 10 ng/ml or less, and Gleason score 6 or less) or very low risk (stage T1c...
Last. Philipp Dahm(UF: University of Florida)H-Index: 60
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Background Any form of screening aims to reduce disease-specific and overall mortality, and to improve a person's future quality of life. Screening for prostate cancer has generated considerable debate within the medical and broader community, as demonstrated by the varying recommendations made by medical organizations and governed by national policies. To better inform individual patient decision-making and health policy decisions, we need to consider the entire body of data from randomised con...
Overtreatment of low-grade prostate cancer (Gleason score ≤ 6) is a recognized problem today, with systematic prostate gland sampling triggered by prostate-specific antigen (PSA) measurements.1 The extent to which overtreatment is caused by fear of death resulting from cancer, fear of litigation from undertreatment, and misaligned incentives that reimburse more for treating rather than monitoring when appropriate is not known. Nevertheless, fear of death resulting from cancer likely plays some r...
#1Virginia A. Moyer(University of Texas Health Science Center at Houston)H-Index: 66
Recommendation: The USPSTF recommends against PSA-based screening for prostate cancer (grade D recommendation). This recommendation applies to men in the general U.S. population, regardless of age. This recommendation does not include the use of the PSA test for surveillance after diagnosis or treatment of prostate cancer; the use of the PSA test for this indication is outside the scope of the USPSTF.
Abstract Background Prior studies assessing the correlation of Gleason score (GS) at needle biopsy and corresponding radical prostatectomy (RP) predated the use of the modified Gleason scoring system and did not factor in tertiary grade patterns. Objective To assess the relation of biopsy and RP grade in the largest study to date. Design, setting, and participants A total of 7643 totally embedded RP and corresponding needle biopsies (2004–2010) were analyzed according to the updated Gleason syst...
Study Type – Diagnostic (case series) Level of Evidence 4 What's known on the subject? and What does the study add? The Gleason score of prostate cancer is frequently underestimated at the time of diagnostic biopsy, although the contribution of sampling error to its incidence is unknown. We show that under-graded tumours are significantly smaller that tumours concordant for the higher grade, indicating that incomplete tumour sampling plays a significant role in Gleason score assignment error. OB...
#1Judson D. Davies(VUMC: Vanderbilt University Medical Center)H-Index: 2
#2Monty Aghazadeh(VUMC: Vanderbilt University Medical Center)H-Index: 8
Last. Daniel A. Barocas(VUMC: Vanderbilt University Medical Center)H-Index: 50
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Purpose: Gleason score upgrading between biopsy and surgical pathological specimens occurs in 30% to 50% of cases. Predicting upgrading in men with low risk prostate cancer may be particularly important since high grade disease influences management decisions and impacts prognosis. We determined whether prostate size predicts Gleason score upgrading in patients with low risk prostate cancer.Materials and Methods: A total of 1,251 consecutive patients with D'Amico low risk disease and complete da...
Study Type – Prognosis (retrospective cohort) Level of Evidence 2b OBJECTIVE • To determine the effect of an upgrade in Gleason score between initial prostate biopsy and final prostatectomy specimen on the risk of postoperative biochemical recurrence. PATIENTS AND METHODS • A total of 1629 patients with paired biopsy and radical prostatectomy histology were identified from two prospectively recorded prostate cancer databases. • Information on key clinical and pathological characteristics as well...
Abstract Objectives To report biopsy-related and oncologic outcomes in a large prospective active surveillance cohort that was initiated in the pre-MRI era and to additionally identify clinical factors associated with disease reclassification in order to inform future studies designed to improve enrollment and follow-up on AS. Methods Patients were prospectively enrolled at a single institution from 2006 to 2014 and followed until 2016. Men with Gleason 6 or 7 disease were eligible, and those wi...
BACKGROUND: Active surveillance (AS) has become a valid option for patients with a very low risk of prostate cancer (PC) with a widespread application. There are still a few series, with a medium follow-up longer than 5 years, reporting data on pathological upgrading. The objective is to evaluate the changes in surveillance biopsies of patients with low-risk PC in a long-term follow-up and determine if a longer stay in AS could involve worse pathological findings. MATERIALS AND METHODS: A retros...
Purpose To evaluate active surveillance (AS) outcomes including overall survival (OS), freedom from distant metastases (FDM), freedom from therapeutic intervention (FTI), and quality of life (QOL) outcomes in prostate cancer patients using transperineal template-guided mapping biopsy (TTMB) for patient selection.
Objectives To determine whether replacement of protocol‐driven repeat prostate biopsy (PB) with multiparametric magnetic resonance imaging (mpMRI) +/‐ targeted repeat prostate biopsy (TB) in evaluating men on active surveillance (AS) for low‐volume low‐ to intermediate‐risk prostate cancer (PCa) altered the likelihood or time to treatment, or reduced the number of repeat biopsies required to trigger treatment. Patients and methods 445 patients underwent AS from 2010‐2016 at our institution with ...
Last. Peter T. Scardino(MSK: Memorial Sloan Kettering Cancer Center)H-Index: 159
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Purpose: The prospective PCM301 trial randomized 413 men with low risk prostate cancer to partial gland ablation with vascular targeted photodynamic therapy in 207 and active surveillance in 206. Two-year outcomes were reported previously. We report 4-year rates of intervention with radical therapy and further assess efficacy with biopsy results.Materials and Methods: Prostate biopsies were mandated at 12 and 24 months. Thereafter patients were monitored for radical therapy with periodic biopsie...
Purpose:The Memorial Anxiety Scale for Prostate Cancer (MAX-PC) is a self-report questionnaire that was developed in English to assess prostate cancer (PCa)-related anxiety. The aim of this study w...