1596: Choices for Definitive Treatment of Early-Stage Prostate Cancer: Results from the Compare Registry

2006 ◽  
Vol 175 (4S) ◽  
pp. 514-514
Author(s):  
David G. McLeod ◽  
Oliver Sartor ◽  
Paul F. Schellhammer ◽  
Anthony V. D'Amico ◽  
Susan Halabi ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Early Stage ◽  
Definitive Treatment

Imaging characteristics of patients with prostate cancer who discontinued active holistic surveillance on 3T multiparametric prostate MRI.

2016 ◽  
Vol 34 (2_suppl) ◽  
pp. 18-18
Author(s):  
Aaron Katz ◽  
Corinne Liu ◽  
Andrew S Fontes ◽  
Kaitlin E. Kosinski
Keyword(s):  
Prostate Cancer ◽  
Early Stage ◽  
Definitive Treatment ◽  
Vitamin Supplements ◽  
Prostate Mri ◽  
Special Diet ◽  
Imaging Characteristics ◽  
Multiparametric Prostate Mri ◽  
Clinically Significant

18 Background: Early-stage patients with prostate cancer can decide to go on Active Holistic Surveillance (AHS) to avoid over-treatment of a disease that has a high probability of being indolent. These patients are also placed on a special diet with vitamin supplements. We evaluate the imaging characteristics of this particular set of patients with prostate cancer with early-stage disease who are on a special diet and vitamin supplements, discontinued AHS and received definitive treatment. Methods: 300 consecutive 3T Multiparametric Prostate MRI (MP-MRI) were identified from March 26, 2012, to June 29, 2015. 200 patients (age 44 to 84 years) were identified in the active surveillance program. 114 patients had an initial MP-MRI prior to starting AHS and had at least one follow up MP-MRI after beginning AHS. 14 (12%) patients (age 60 to 79 years) discontinued AHS due to changes on a follow up MRI suggesting clinically significant prostate cancer. The MRI imaging findings were evaluated and correlated with pathology results, if available. Results: Of 14 patients, 3 (21%) patients had an enlarging MRI lesion compared to a previous MRI, 2 (14 %) patients had a new MRI lesion(s) suspicious for cancer, and 9 (64%) patients had suspicion or confirmation of extracapsular extension. 7 (50%) patients had a biopsy after a follow up MP-MRI with 6 (43%) demonstrating tumor upgrading. Length of time on AHS ranged from 4 months to 110 months. Prostate-specific antigen (PSA) levels and PSA density prior to beginning AHS ranged from 4.8 to 12.0 and 0.04 to 0.39, respectively. All were treated with definitive treatment, majority with unilateral focal cryoablation. Conclusions: The small number of patients with worsening disease on follow-up MP-MRI supports the role of AHS in patients with early-stage prostate cancer. MP-MRI is a useful tool in following patients on AHS and can extract patients who potentially may have clinically significant cancer and who may benefit from definitive treatment.

scholarly journals PSA Testing Use and Prostate Cancer Diagnostic Stage After the 2012 U.S. Preventive Services Task Force Guideline Changes

2019 ◽  
Vol 17 (7) ◽  
pp. 795-803 ◽  
Author(s):  
Christopher J. Magnani ◽  
Kevin Li ◽  
Tina Seto ◽  
Kathryn M. McDonald ◽  
Douglas W. Blayney ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Task Force ◽  
Early Stage ◽  
Preventive Services ◽  
Definitive Treatment ◽  
Low Grade ◽  
Seer Database ◽  
Psa Screening ◽  
Psa Testing ◽  
Academic Center

ABSTRACTBackground: Most patients with prostate cancer are diagnosed with low-grade, localized disease and may not require definitive treatment. In 2012, the U.S. Preventive Services Task Force (USPSTF) recommended against prostate cancer screening to address overdetection and overtreatment. This study sought to determine the effect of guideline changes on prostate-specific antigen (PSA) screening and initial diagnostic stage for prostate cancer. Patients and Methods: A difference-in-differences analysis was conducted to compare changes in PSA screening (exposure) relative to cholesterol testing (control) after the 2012 USPSTF guideline changes, and chi-square test was used to determine whether there was a subsequent decrease in early-stage, low-risk prostate cancer diagnoses. Data were derived from a tertiary academic medical center’s electronic health records, a national commercial insurance database (OptumLabs), and the SEER database for men aged ≥35 years before (2008–2011) and after (2013–2016) the guideline changes. Results: In both the academic center and insurance databases, PSA testing significantly decreased for all men compared with the control. The greatest decrease was among men aged 55 to 74 years at the academic center and among those aged ≥75 years in the commercial database. The proportion of early-stage prostate cancer diagnoses (<T2) decreased across age groups at the academic center and in the SEER database. Conclusions: In primary care, PSA testing decreased significantly and fewer prostate cancers were diagnosed at an early stage, suggesting provider adherence to the 2012 USPSTF guideline changes. Long-term follow-up is needed to understand the effect of decreased screening on prostate cancer survival.

Initial results of patients with early-stage prostate cancer on active holistic surveillance.

2016 ◽  
Vol 34 (2_suppl) ◽  
pp. 19-19
Author(s):  
Aaron Katz ◽  
Andrew S Fontes ◽  
Kaitlin E. Kosinski
Keyword(s):  
Prostate Cancer ◽  
Active Surveillance ◽  
Early Stage ◽  
Clinical Stage ◽  
Retrospective Chart Review ◽  
Lifestyle Changes ◽  
Definitive Treatment ◽  
Intermediate Risk ◽  
Treatment Rate ◽  
Definitive Therapy

19 Background: There is currently no consensus on how active surveillance should be utilized in order to optimize the benefit of patients with prostate cancer (PCa) to prevent overtreatment. Our institution’s protocol, known as Active Holistic Surveillance (AHS) integrates MRI screening in the place of serial biopsies. Nutritional supplements and lifestyle changes are also suggested in order to provide a holistic way to reduce progression. We look to compare definitive treatment rates of our cohort on AHS to other publications in the literature. Methods: A retrospective chart review was conducted on 200 patients placed on active surveillance for low and low-intermediate risk PCa under D’Amico criteria from February 2002 to July 2015. Enrollment criteria was defined by clinical stage (T1c), PSA under 20 ng/mL, diagnosis of a Gleason 6 or Gleason 7 with a tumor volume of >50%, and a PSA doubling time of greater than 1 year. The main objective of the study was to evaluate the rate of patients discontinuing AHS to receive definitive therapy and reasons for leaving our AHS protocol. Results: 200 patients (age 44-84 years) have a median follow-up of 40 months (range 4-161). A total of 24 out of 200 patients (12%) moved on to definitive treatment. For patients on AHS before 2010 until 2012, the rates of definitive treatment were 0%. In 2013, 8 patients (4%) received definitive treatment. In 2014, 12 patients (6%) received definitive treatment. In 2015, 4 patients (2%) received definitive treatment to date.The average treatment rate per year is 4%. Reasons for 24 patients discontinuing AHS included biopsy progression (16.67%), MRI progression (29.17%), MRI progression with biopsy confirmation (29.17%), patient preference (20.83%), and 1 patient was deceased due to an unrelated illness (4.17%). Conclusions: Low rates of discontinuation compared to other publications in the literature demonstrate that AHS can be a successful protocol for low-risk and low-intermediate risk PCa patients, and that a holistic approach can be beneficial to active surveillance patients.

scholarly journals Future Prospects in the Diagnosis and Management of Localized Prostate Cancer

2013 ◽  
Vol 2013 ◽  
pp. 1-9 ◽  
Author(s):  
Ahmet Tefekli ◽  
Murat Tunc
Keyword(s):  
Prostate Cancer ◽  
Radiation Therapy ◽  
Early Stage ◽  
External Beam Radiation ◽  
Definitive Treatment ◽  
Management Approach ◽  
Success Rates ◽  
Beam Radiation ◽  
Diagnosis And Management ◽  
Specificity And Sensitivity

Prostate cancer (PCa) is the commonest visceral cancer in men worldwide. Introduction of serum PSA as a highly specific biomarker for prostatic diseases has led to a dramatic increase in the diagnosis of early stage PCa in last decades. Guidelines underline that benefits as well as risks and squeals of early diagnosis and treatment should be discussed with patients. There are several new biomarkers (Pro-PSA, PCA-3 test, and TMPRSS2-ERG) available on the market but new ones are awaited in order to improve specificity and sensitivity. Investigators have also focused on identifying and isolating the gene, or genes, responsible for PCa. Current definitive treatment options for clinically localized PCa with functional and oncological success rates up to 95% include surgery (radical prostatectomy), external-beam radiation therapy, and interstitial radiation therapy (brachytherapy). Potential complications of overdiagnosis and overtreatment have resulted in arguments about screening and introduced a new management approach called “active surveillance.” Improvements in diagnostic techniques, especially multiparametric magnetic resonance imaging, significantly ameliorated the accuracy of tumor localization and local staging. These advances will further support focal therapies as emerging treatment alternatives for localized PCa. As a conclusion, revolutionary changes in the diagnosis and management of PCa are awaited in the near future.

1068: TP53 Gene Mutations as a Prognostic Marker for PSA Progression in Early Stage Prostate Cancer

2004 ◽  
Vol 171 (4S) ◽  
pp. 282-282
Author(s):  
Markus D. Sachs ◽  
Horst Schlechte ◽  
Katrin Schiemenz ◽  
Severin V. Lenk ◽  
Dietmar Schnorr ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Prognostic Marker ◽  
Early Stage ◽  
Gene Mutations ◽  
Tp53 Gene ◽  
Psa Progression ◽  
Tp53 Gene Mutations
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