Safety Of Active Surveillance Research Articles

Active surveillance for clinically localized prostate cancer––A systematic review

Active surveillance (AS) has been introduced as an observational strategy to delay or avoid curative treatment without compromising long-term cancer-specific survival. The 10 studies included in this review, published between 2008 and 2013, generally agreed upon patients selection for the AS strategy and how they should be managed within the program. However, uncertainties persists concerning optimal patient selection and reliable progression criteria, as well as the long-term safety of AS.

Managing localized prostate cancer in the era of prostate‐specific antigen screening

A predictive tool has been developed and validated that identifies patients with low‐risk cancer on biopsy who are at risk for upgrading at surgery. This tool could help increase acceptance and safety of active surveillance and lower the number of men overtreated for low‐risk prostate cancer.

Ongoing Debate on the Management of Small Renal Masses: Should They Be Treated Like Low-Risk Prostate Cancers?

Ongoing Debate on the Management of Small Renal Masses: Should They Be Treated Like Low-Risk Prostate Cancers?

Active Surveillance for Low-Risk Prostate Cancer Worldwide: The PRIAS Study

BackgroundOverdiagnosis and subsequent overtreatment are important side effects of screening for, and early detection of, prostate cancer (PCa). Active surveillance (AS) is of growing interest as an alternative to radical treatment of low-risk PCa. ObjectiveTo update our experience in the largest worldwide prospective AS cohort. Design, setting, and participantsEligible patients had clinical stage T1/T2 PCa, prostate-specific antigen (PSA) ≤10 ng/ml, PSA density <0.2 ng/ml per milliliter, one or two positive biopsy cores, and Gleason score ≤6. PSA was measured every 3–6 mo, and volume-based repeat biopsies were scheduled after 1, 4, and 7 yr. Reclassification was defined as more than two positive cores or Gleason >6 at repeat biopsy. Recommendation for treatment was triggered in case of PSA doubling time <3 yr or reclassification. Outcome measurements and statistical analysisMultivariate regression analysis was used to evaluate predictors for reclassification at repeat biopsy. Active therapy–free survival (ATFS) was assessed with a Kaplan-Meier analysis, and Cox regression was used to evaluate the association of clinical characteristics with active therapy over time. Results and limitationsIn total, 2494 patients were included and followed for a median of 1.6 yr. One or more repeat biopsies were performed in 1480 men, of whom 415 men (28%) showed reclassification. Compliance with the first repeat biopsy was estimated to be 81%. During follow-up, 527 patients (21.1%) underwent active therapy. ATFS at 2 yr was 77.3%. The strongest predictors for reclassification and switching to deferred treatment were the number of positive cores (two cores compared with one core) and PSA density. The disease-specific survival rate was 100%. Follow-up was too short to draw definitive conclusions about the safety of AS. ConclusionsOur short-term data support AS as a feasible strategy to reduce overtreatment. Clinical characteristics and PSA kinetics during follow-up can be used for risk stratification. Strict monitoring is even more essential in men with high-risk features to enable timely recognition of potentially aggressive disease and offer curative intervention. Limitations of using surrogate end points and markers in AS should be recognized. Trial registrationThe current program is registered at the Dutch Trial Register with ID NTR1718 (http://www.trialregister.nl/trialreg/admin/rctview.asp?TC=1718).

UP.06: Efficacy and Safety of Active Surveillance for Testicular Cancer

UP.06: Efficacy and Safety of Active Surveillance for Testicular Cancer