Active Surveillance Criteria Research Articles

Active surveillance for the management of prostate cancer in a contemporary cohort

Active surveillance followed by selective treatment for men who have evidence of disease progression may be an option for select patients with early-stage prostate cancer. In this article, the authors report their experience in a contemporary cohort of men with prostate cancer who were managed with active surveillance. All men who were managed initially with active surveillance were identified through the authors' institutional database. Selection criteria for active surveillance included: prostate-specific antigen (PSA)<10 ng/mL, biopsy Gleason sum </=6 with no pattern 4 or 5, cancer involvement of <33% of biopsy cores, and clinical stage T1/T2a tumor. Patients were followed with PSA measurements and digital rectal examination every 3 to 6 months and with transrectal ultrasound at 6- to 12-month intervals. Beginning in 2003, patients also underwent repeat prostate biopsy at 12 to 24 months. The primary outcome measured was active treatment. Evidence of disease progression, defined as an increase in rebiopsy Gleason sum or significant PSA velocity changes (>0.75 ng/mL per year), was a secondary outcome. Chi-square and log-rank tests were used to compare groups. The association between clinical characteristics and receipt of active treatment was analyzed by using Cox proportional hazards regression. Three hundred twenty-one men (mean age [+/-standard deviation]: 63.4+/-8.5 years) selected active surveillance as their initial management. The overall median follow-up was 3.6 years (range, 1-17 years). The initial mean PSA level was 6.5+/-3.9 ng/mL. One hundred twenty men (37%) met at least 1 criterion for progression. Overall, 38% of men had higher grade on repeat biopsy, and 26% of men had a PSA velocity>0.75 ng/mL per year. Seventy-eight men (24%) received secondary treatment at a median 3 years (range, 1-17 years) after diagnosis. Approximately 13% of patients with no disease progression elected to obtain treatment. PSA density at diagnosis and rise in Gleason score on repeat biopsy were associated significantly with receipt of secondary treatment. The disease-specific survival rate was 100%. Selected individuals with early-stage prostate cancer may be candidates for active surveillance. Specific criteria can be and need to be developed to select the most appropriate individuals for this form of management and to monitor disease progression. A small attrition rate can be expected because of men who are unable or unwilling to tolerate surveillance.

CURRENTLY USED CRITERIA FOR ACTIVE SURVEILLANCE IN MEN WITH LOW RISK PROSTATE CANCER. AN ANALYSIS OF PATHOLOGICAL FEATURES

You have accessJournal of Urology1 Apr 2008CURRENTLY USED CRITERIA FOR ACTIVE SURVEILLANCE IN MEN WITH LOW RISK PROSTATE CANCER. AN ANALYSIS OF PATHOLOGICAL FEATURES Nazareno Suardi, Felix KH Chun, Claudio Jeldres, Alexander Haese, Alberto Briganti, Andrea Gallina, Andrea Salonia, Markus Graefen, Hartwig Huland, Francesco Montorsi, and Pierre I Karakiewicz Nazareno SuardiNazareno Suardi More articles by this author , Felix KH ChunFelix KH Chun More articles by this author , Claudio JeldresClaudio Jeldres More articles by this author , Alexander HaeseAlexander Haese More articles by this author , Alberto BrigantiAlberto Briganti More articles by this author , Andrea GallinaAndrea Gallina More articles by this author , Andrea SaloniaAndrea Salonia More articles by this author , Markus GraefenMarkus Graefen More articles by this author , Hartwig HulandHartwig Huland More articles by this author , Francesco MontorsiFrancesco Montorsi More articles by this author , and Pierre I KarakiewiczPierre I Karakiewicz More articles by this author View All Author Informationhttps://doi.org/10.1016/S0022-5347(08)60437-1AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail "CURRENTLY USED CRITERIA FOR ACTIVE SURVEILLANCE IN MEN WITH LOW RISK PROSTATE CANCER. AN ANALYSIS OF PATHOLOGICAL FEATURES." The Journal of Urology, 179(4S), p. 152 © 2008 by American Urological AssociationFiguresReferencesRelatedDetails Volume 179Issue 4SApril 2008Page: 152 Advertisement Copyright & Permissions© 2008 by American Urological AssociationMetricsAuthor Information Nazareno Suardi More articles by this author Felix KH Chun More articles by this author Claudio Jeldres More articles by this author Alexander Haese More articles by this author Alberto Briganti More articles by this author Andrea Gallina More articles by this author Andrea Salonia More articles by this author Markus Graefen More articles by this author Hartwig Huland More articles by this author Francesco Montorsi More articles by this author Pierre I Karakiewicz More articles by this author Expand All Advertisement PDF DownloadLoading ...

Prospective Evaluation of Selection Criteria for Active Surveillance in Japanese Patients with Stage T1cN0M0 Prostate Cancer

Selection criteria for active surveillance (AS) program of localized prostate cancer remain to be standardized. The purpose was to evaluate the validity of selection criteria and investigate the feasibility of this AS program. Patients meeting the criteria (i) stage T1cN0M0, (ii) age 50-80, (iii) serum prostate-specific antigen (PSA) </=20 ng/ml, (iv) one or two positive cores per 6-12 systematic biopsy cores, (v) Gleason score </=6, and (vi) cancer involvement in positive core </=50% were enrolled and encouraged to start AS for at least 6 months during the period between January 2002 and December 2003. PSA was measured bimonthly for 6 months and every 3 months thereafter. Trigger of treatment recommendation was PSA-doubling time (PSADT) of </=2 years or pathological progression at re-biopsy. Primary endpoint was '%PSADT > 2y', which was defined as the proportion of patients who showed PSADT assessed at 6 months >2 years out of all the patients who chose AS. Point estimate of '%PSADT > 2y' was expected to be >80%. One hundred and eighteen patients opted for AS and 16 chose immediate treatment at enrollment. PSADT for the initial 6 months based on four measurements could be assessed in 106 patients. Intent-to-treat analysis of '%PSADT > 2y' was 71.2% (84/118, 95% CI: 62.1-79.2). Pathological progression rate at 1-year re-biopsy was 33%. Fifty-four (46%) patients remained on AS for maximal observation of 54 months. General health-related QOL in patients undergoing AS was not impaired. The primary endpoint, '%PSADT > 2y', did not meet the pre-specified decision criteria. Further prospective study with revised program and endpoint is needed.

Management and Survival of Screen-Detected Prostate Cancer Patients who Might Have Been Suitable for Active Surveillance

ObjectiveScreening practices for prostate cancer have resulted in an increasing incidence of prostate cancers. Our knowledge about which prostate cancers are life threatening and which are not is limited. Thus, for ethical, medical, and economic reasons we need to define which patients can be managed by active surveillance. MethodsFrom 1993 through 1999, men from the Rotterdam section of the European Randomized study of Screening for Prostate Cancer (ERSPC) were screened by two strict protocols, which were based on prostate-specific antigen (PSA), digital rectal examination, and transrectal ultrasound. For this study, men with criteria that reflect current active surveillance studies were selected: those with a biopsy Gleason score ≤3+3 in two or fewer cores, with a PSA density <0.2 and a maximum PSA-level of 15ng/ml. Clinical stage had to be T1C or T2. ResultsOf the 1,014 prostate cancers detected in the prevalence screen, 293 men (28.9%) met the criteria for active surveillance. Their mean age was 65.7 and the mean PSA level was 4.8ng/ml. Radical prostatectomy was elected by 136 men (46.4%), radiotherapy by 91 (31.1%), and watchful waiting by 64 (21.8%). The mean follow-up was 80.8 months. The eight-year prostate cancer-specific survival was 99.2%; the overall survival was 85.4%. Nineteen men who chose watchful waiting changed to definitive treatment during follow-up. ConclusionOnly three men died of prostate cancer, none of whom were on watchful waiting. Our observations provide preliminary validation of the arbitrary selection criteria for active surveillance.