There is strong evidence that low risk and many cases of low-intermediate risk prostate cancer are indolent, have little or no metastatic potential, and do not pose a threat to the patient in his lifetime (clinically insignificant). We have made major strides in understanding who these patients are, and in counseling the use of conservative management in such individuals. A key component of this approach is the early identification of those “low risk” patients who harbor higher risk disease, and are likely to benefit from definitive therapy. This represents about 30 % of newly diagnosed low risk patients. A further small proportion of patients with low risk disease demonstrate biological progression to higher grade disease. The results of active surveillance, embodying conservative management with selective delayed intervention for the subset who are re-classified as higher risk over time based on repeat biopsy, imaging, or biomarker results, have shown that this approach is safe in the intermediate to long term, with a 3 % cancer-specific mortality at 10–15 years. Further refinement of the surveillance approach is ongoing, incorporating MRI and targeted biopsies. For patients with an identifiable target, focal therapy represents a complementary approach designed to conserve tissue and quality of life which eradicating the “index,” or life-threatening lesion. Thermal ablation using focused ultrasound or interstitial laser, cryoablation, electroporation, and brachytherapy have all been applied in a focal fashion with promising results.
Background: Risk prediction models that incorporate biomarkers and clinicopathologic variables may be used to improve decision making after radical prostatectomy (RP). We compared two previously validated post-RP classifiers—the Cancer of the Prostate Risk Assessment Postsurgical (CAPRA-S) and the Decipher genomic classifier (GC)—to predict prostate cancer–specific mortality (CSM) in a contemporary cohort of RP patients. Objective: To evaluate the combined prognostic ability of CAPRA-S and GC to...
#1Laurence Klotz(U of T: University of Toronto)H-Index: 85
#2Danny Vesprini(U of T: University of Toronto)H-Index: 33
Last. Andrew Loblaw(U of T: University of Toronto)H-Index: 35
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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 a...
Last. Mahesh Desai(Muljibhai Patel Urological Hospital)H-Index: 36
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Objective To demonstrate our experience with the use of ultrasound (USG) for puncture guidance while performing percutaneous nephrolithotomy in ectopic pelvic kidneys. Methods From January 1990 to December 2013, we have performed percutaneous nephrolithotomy in 26 patients with USG-guided punctures. The stones were solitary in 15 patients (58%) and multiple in 11 patients (42%). The mean stone size was 22 mm (range, 10-50 mm), including 3 staghorn calculi. All procedures were performed in an obl...
Objective To evaluate the risk of reclassification on serial biopsy for Caucasian and African American (AA) men with very low-risk (VLR) prostate cancer enrolled in a large prospective active surveillance (AS) registry. Methods The Johns Hopkins AS registry is a prospective observational study that has enrolled 982 men since 1994. Including only men who met all National Comprehensive Cancer Network VLR criteria (clinical stage ≤T1, Gleason score ≤6, prostate-specific antigen [PSA] level <10 ng/m...
Last. Carlo Catalano(Sapienza University of Rome)H-Index: 71
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Abstract Objectives To assess whether the proportion of men with clinically significant prostate cancer (PCa) is higher among men randomized to multiparametric magnetic resonance imaging (mp-MRI)/biopsy vs. those randomized to transrectal ultrasound (TRUS)-guided biopsy. Methods In total, 1,140 patients with symptoms highly suggestive of PCa were enrolled and divided in 2 groups of 570 patients to follow 2 different diagnostic algorithms. Group A underwent a TRUS-guided random biopsy. Group B un...
Objective To evaluate the clinical and pathological factors influencing the risk of disease progression in a cohort of patients with low–intermediate risk prostate cancer under active surveillance (AS). Patients and Methods We studied 300 patients diagnosed between 1992 and 2012 with prostate adenocarcinoma with favourable parameters or who refused treatment and were managed with AS. Of those, 155 patients with at least one repeat biopsy and no progression criteria at the time of the diagnosis w...
#1Nabeel Shakir(NIH: National Institutes of Health)H-Index: 13
#2Arvin K. George(NIH: National Institutes of Health)H-Index: 29
Last. Peter A. Pinto(NIH: National Institutes of Health)H-Index: 65
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Purpose: Prostate specific antigen sensitivity increases with lower threshold values but with a corresponding decrease in specificity. Magnetic resonance imaging/ultrasound targeted biopsy detects prostate cancer more efficiently and of higher grade than standard 12-core transrectal ultrasound biopsy but the optimal population for its use is not well defined. We evaluated the performance of magnetic resonance imaging/ultrasound targeted biopsy vs 12-core biopsy across a prostate specific antigen...
Resumen Objetivos Conocer la informacion necesaria para reproducir los resultados de la literatura en vigilancia activa (VA) en cancer de prostata (CaP) en nuestro propio centro, de tal forma que dicha informacion sea objetiva y se le pueda dar al paciente de forma fehaciente. Contemplamos estudiar el porcentaje de pacientes candidatos a VA y que la escogen en nuestro ambiente, los datos de infraestadificacion, infragradacion y prediccion de CaP insignificante, depurar el poder predictivo de dis...
Active surveillance (AS) has evolved as a strategy alternative to radical treatments for very low risk and low-risk prostate cancer (PCa). However, current criteria for selecting AS patients are still suboptimal. Here, we performed an unprecedented analysis of the circulating miRNome to investigate whether specific miRNAs associated with disease reclassification can provide risk refinement to standard clinicopathological features for improving patient selection. The global miRNA expression profi...
#1Sean F. Mungovan(Swinburne University of Technology)H-Index: 5
Last. Manish I. Patel(USYD: University of Sydney)H-Index: 27
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Urinary incontinence is a common and predictable consequence among men with localized prostate cancer who have undergone radical prostatectomy. Despite advances in the surgical technique, urinary continence recovery time remains variable. A range of surgical and patient-related risk factors contributing to urinary incontinence after radical prostatectomy have been described, including age, BMI, membranous urethral length and urethral sphincter insufficiency. Physical activity interventions incor...
#1Glenda Kith(UCSF: University of California, San Francisco)H-Index: 2
#2Sarah Lisker(UCSF: University of California, San Francisco)H-Index: 3
Last. Nynikka R. Palmer(UCSF: University of California, San Francisco)H-Index: 12
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Abstract Context Evidence-based guidelines for active surveillance (AS), a treatment option for men with low-risk prostate cancer, recommend regular follow-up at periodic intervals to monitor disease progression. However, gaps in monitoring can lead to delayed detection of cancer progression, leading to a missed window of curability. Objective We aimed to identify the extent to which real-world observational studies reported adherence to monitoring protocols among prostate cancer patients on AS....
#1Chun-Te Wu(Memorial Hospital of South Bend)H-Index: 21
#1Chun-Te Wu(Memorial Hospital of South Bend)H-Index: 5
Last. Miao-Fen Chen(CGU: Chang Gung University)H-Index: 22
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Regarding localized prostate cancer (PC), questions remain regarding which patients are appropriate candidates for conservative management. Some localized PC was an incidental finding in patients who received transurethral resection of the prostate (TURP) for urinary symptoms. It is known that TURP usually affects the level of prostate-specific antigen (PSA). In the present study, we examined whether changes in PSA levels after TURP possess a predictive value for localized PC. We retrospectively...
Background The psychological burden possibly deriving from not immediately undergoing radical treatment for prostate cancer (PCa) could be a potential disadvantage of active surveillance (AS), especially in the eve of some relevant clinical exams [i.e., re-biopsy, prostate-specific antigen (PSA) test, and medical examination]. Even if it is known from the literature that the majority of PCa men in AS do not report heightened anxiety, there is a minority of patients who show clinically significan...
#1Mitchell Daun(UCI: University of California, Irvine)H-Index: 1
#2Sara Fardin(UCI: University of California, Irvine)H-Index: 2
Last. Roozbeh Houshyar(UCI: University of California, Irvine)H-Index: 9
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Abstract Objectives To assess the utility of multiparametric MRI (mpMRI) in detecting clinically significant prostate cancer (csPCa) by comparing PI-RADSv2 scores with International Society of Urological Pathology (ISUP) pathologic grading criteria. Methods Data from 137 patients was retrospectively analyzed. PI-RADSv2 scores were compared with pathological grade using ISUP criteria. Pathological grades were divided into clinically significant (groups 3-5) and clinically insignificant lesions (g...
OBJECTIVES: The focus of this study is the classification accuracy of the Montreal Cognitive Assessment (MoCA) for the detection of cognitive impairment (CI). Classification accuracy can be low when the prevalence of CI is either high or low in a clinical sample. A more robust result can be expected when avoiding the range of test scores within which most classification errors are expected, with adequate predictive values for more clinical settings. METHODS: The classification methods have been ...
Last. Karim Touijer(MSK: Memorial Sloan Kettering Cancer Center)H-Index: 46
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Purpose:To report oncologic outcomes for men with Grade Group 1 prostate cancer managed with active surveillance (AS) at a tertiary cancer center.Materials and Methods:2,907 patients were managed w...
OBJECTIVE: To formulate consensus statements to facilitate physician management strategies for patients with clinically localized prostate cancer (PCa) in Hong Kong by jointly convening a panel of 12 experts from the two local professional organizations representing PCa specialists, who had previously established consensus statements on the management of metastatic PCa for the locality. METHODS: Through a series of meetings, the panellists discussed their clinical experience and the published ev...