Purpose Active surveillance is increasingly accepted as a treatment option for favorable-risk prostate cancer. Long-term follow-up has been lacking. In this study, we report the long-term outcome of a large active surveillance protocol in men with favorable-risk prostate cancer. Patients and Methods In a prospective single-arm cohort study carried out at a single academic health sciences center, 993 men with favorable- or intermediate-risk prostate cancer were managed with an initial expectant approach. Intervention was offered for a prostate-specific antigen (PSA) doubling time of less than 3 years, Gleason score progression, or unequivocal clinical progression. Main outcome measures were overall and disease-specific survival, rate of treatment, and PSA failure rate in the treated patients. Results Among the 819 survivors, the median follow-up time from the first biopsy is 6.4 years (range, 0.2 to 19.8 years). One hundred forty-nine (15%) of 993 patients died, and 844 patients are alive (censored rate, 8...
#1Suneil Jain('QUB': Queen's University Belfast)H-Index: 28
#2Andrew Loblaw(Sunnybrook Health Sciences Centre)H-Index: 35
Last. Laurence Klotz(U of T: University of Toronto)H-Index: 85
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Purpose: We report the percentage of patients on active surveillance who had disease pathologically upgraded and factors that predict for upgrading on surveillance biopsies.Materials and Methods: Patients in our active surveillance database with at least 1 repeat prostate biopsy were included. Histological upgrading was defined as any increase in primary or secondary Gleason grade on repeat biopsy. Multivariate analysis was used to determine baseline and dynamic factors associated with Gleason u...
#1Christopher J. Welty(UCSF: University of California, San Francisco)H-Index: 12
Last. Peter R. Carroll(UCSF: University of California, San Francisco)H-Index: 141
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Purpose: Active surveillance to manage prostate cancer provides an alternative to immediate treatment in men with low risk prostate cancer. We report updated outcomes from a long-standing active surveillance cohort and factors associated with reclassification.Materials and Methods: We retrospectively reviewed data on all men enrolled in the active surveillance cohort at our institution with at least 6 months of followup between 1990 and 2013. Surveillance consisted of quarterly prostate specific...
Background: Most localized prostate cancers are believed to have an indolent course. Within 15 yr of diagnosis, most deaths among men with prostate cancer (PCa) can be attributed to other competing causes. However, data from studies with extended follow-up are insufficient to determine appropriate treatment for men with localized disease. Objective: To investigate the long-term natural history of untreated, early-stage PCa. Design, setting, and participants: We conducted a population-based, pros...
#1Andrew Loblaw(Sunnybrook Health Sciences Centre)H-Index: 35
#2Liying Zhang(Sunnybrook Health Sciences Centre)H-Index: 44
Last. Laurence Klotz(Sunnybrook Health Sciences Centre)H-Index: 85
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Purpose: We determined the proportion of men with nonprogressive prostate cancer on active surveillance who had a trigger for treatment using various measures of prostate specific antigen kinetics.Materials and Methods: A prospective phase II study of patients with favorable clinical parameters (stage T1b-T2b N0M0, Gleason sum 7 or less, prostate specific antigen 15 ng/ml or less) on active surveillance was initiated in 1995. Those patients considered at high risk for progression were offered ra...
#1Laurence Klotz(Sunnybrook Health Sciences Centre)H-Index: 85
#2Liying Zhang(Sunnybrook Health Sciences Centre)H-Index: 44
Last. Andrew Loblaw(Sunnybrook Health Sciences Centre)H-Index: 35
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Purpose We assessed the outcome of a watchful-waiting protocol with selective delayed intervention by using clinical prostate-specific antigen (PSA), or histologic progression as treatment indications for clinically localized prostate cancer. Patients and Methods This was a prospective, single-arm, cohort study. Patients were managed with an initial expectant approach. Definitive intervention was offered to those patients with a PSA doubling time of less than 3 years, Gleason score progression (...
Last. Hans Lilja(MSK: Memorial Sloan Kettering Cancer Center)H-Index: 108
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Purpose Pretreatment prostate-specific antigen (PSA) dynamics (PSA velocity and PSA doubling time) are widely advocated as useful prognostic markers in prostate cancer. We aimed to assess the published evidence for the clinical utility of PSA dynamics in this population. Methods We conducted a systematic review of studies published before March 2007 in which a PSA dynamic (velocity or doubling time) was calculated in patients before definitive treatment, a subsequent event (such as biopsy or rec...
#1Nicholas van As(The Royal Marsden NHS Foundation Trust)H-Index: 17
#2Andrew R. Norman(The Royal Marsden NHS Foundation Trust)H-Index: 33
Last. Chris Parker(The Royal Marsden NHS Foundation Trust)H-Index: 83
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Abstract Objectives Outcome data from a prospective study of active surveillance of localised prostate cancer were analysed to identify factors, present at the time of diagnosis, that predict subsequent radical treatment. Methods Eligible patients had clinical stage T1–T2a, N0–Nx, M0–Mx adenocarcinoma of the prostate with serum PSA 1ng/ml/yr) or histological progression (primary Gleason grade ≥ 4, or %pbc > 50%). Multivariate Cox regression analysis of baseline variables was performed with respe...
Objective We sought to evaluate outcomes after radical prostatectomy among men with low-risk prostate cancer who would be candidates for active surveillance. Methods Using the Shared Equal Access Regional Cancer Hospital (SEARCH) database of men treated with radical prostatectomy at multiple equal-access medical centers between 1988 and 2007, 398 of 2062 men (19%) met our criteria for potential active surveillance: clinical stage T1c or T2a, prostate-specific antigen (PSA) Results Of the men wit...
#1H. Ballentine Carter(JHUSOM: Johns Hopkins University School of Medicine)H-Index: 79
#2Anna Kettermann(NIH: National Institutes of Health)H-Index: 12
Last. Jonathan I. Epstein(JHUSOM: Johns Hopkins University School of Medicine)H-Index: 163
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Purpose: We updated our experience with a strategy of expectant treatment for men with stage T1c prostate cancer and evaluated predictors of disease intervention.Materials and Methods: A total of 407 men with a median age of 65.7 years (range 45.8 to 81.5) with stage T1c (99.8%) or T2a (0.2%) prostate cancer suspected of harboring small volume prostate cancer based on needle biopsy findings and prostate specific antigen density have been followed in a prospective, longitudinal surveillance progr...
OBJECTIVE To examine the outcome of patients diagnosed with ‘low-risk’ prostate cancer managed by active surveillance (AS). PATIENTS AND METHODS In all, 157 men with localized prostate cancer were followed on AS. The inclusion criteria for AS included: Gleason score of ≤ 6, a serum prostate-specific antigen (PSA) level of ≤15 ng/mL, stage ≤ T2, low-volume disease and >12 months of follow-up. The follow-up was rigorous, with PSA tests and a digital rectal examination every 3 months for 2 years, a...
Active surveillance (AS) in prostate cancer (PCa) represents a curative alternative for men with localised low-risk PCa. Continuous improvement of AS patient’s selection and surveillance modalities aims at reducing misclassification, simplifying modalities of surveillance and decreasing need for invasive procedures such repeated biopsies. Biomarkers represent interesting tools to evaluate PCa diagnosis and prognosis, of which many are readily available or under evaluation. The aim of this review...
Last. Adam C. Reese(TU: Temple University)H-Index: 19
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Abstract null null Introduction null Active surveillance outcomes in minority patients are poorly characterized, as most surveillance series are comprised primarily of Caucasian men. We aimed to characterize outcomes of African American and Hispanic men undergoing surveillance and to identify factors associated with transition to definitive treatment. null null null Material and Methods null We performed a retrospective analysis of men undergoing active surveillance at our institution. Reasons f...
OBJECTIVES To present an overview of radiation therapy (RT) for prostate cancer over the past decade. METHODS The literature on prostate cancer radiation therapy was reviewed and summarised. Radiation therapy (RT) for prostate cancer has dramatically evolved in the past decade, with superior techniques and exciting advances, pushing the role of the radiation oncologist to new frontiers. RESULTS Innovations in imaging, treatment delivery, and a deeper understanding of biology has resulted in more...
Last. Kae Jack Tay(SGH: Singapore General Hospital)H-Index: 14
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Objectives To evaluate the impact of intra-lesional heterogeneity on the performance of multiparametric MRI (mpMRI) in determining cancer extent and treatment margins for focal therapy (FT) of prostate cancer. Patients and methods We identified men who underwent primary radical prostatectomy for organ confined prostate cancer over a 3-year period. Cancer foci on wholemount histology were marked out, coding low-grade (Gleason 3) and high-grade (Gleason 4-5) components separately. Measurements of ...
Last. C. Hawks(UWA: University of Western Australia)H-Index: 3
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OBJECTIVE To determine whether the addition of inhaled methoxyflurane to periprostatic infiltration of local anaesthetic (PILA) during transrectal ultrasonography-guided prostate biopsies (TRUSBs) improved pain and other aspects of the experience. PATIENTS AND METHODS We conducted a multicentre, placebo-controlled, double-blind, randomized phase 3 trial, involving 420 men undergoing their first TRUSB. The intervention was PILA plus a patient-controlled device containing either 3 mL methoxyfluran...
BACKGROUND Decipher Biopsy is a commercially available gene expression classifier used in risk stratification of newly diagnosed prostate cancer (PCa). Currently, there are no prospective data evaluating its clinical utility. We seek to assess the clinical utility of Decipher Biopsy in localized PCa patients. METHODS A multi-institutional study of 855 men who underwent Decipher Biopsy testing between February 2015 and October 2019. All patients were tracked through the prospective Michigan Urolo...
MRI in active surveillance of men with low-risk prostate cancer resulted in a higher quality-adjusted life expectancy and increased cost-effectiveness compared with watchful waiting or surveillance...
Last. Antti Rannikko(UH: University of Helsinki)H-Index: 30
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BACKGROUND Living with an untreated cancer may alter quality of life (QoL) in the long term. OBJECTIVE To prospectively study long-term changes in general, mental, and physical QoL in a contemporary active surveillance (AS) patient cohort with low-risk prostate cancer (PCa). DESIGN, SETTING, AND PARTICIPANTS The study population consisted of patients enrolled in the PRIAS trial in Helsinki University Hospital (n = 348). The RAND-36 questionnaire was used to assess general QoL at the start of AS ...