A longitudinal study of patients undergoing active surveillance for low grade prostate cancer diagnosed at Transperineal Template Prostate Mapping

Overview: Prostate cancer is a ubiquitous disease, affecting as many as two-thirds of men in their 60s. Through widespread prostate-specific antigen (PSA) testing, increasing rates of prostate biopsy, and increased sampling of the prostate, a larger fraction of low-grade, low-volume tumors have been detected, consistent with tumors often found at autopsy. These tumors have historically been treated in a manner similar to that used for higher-grade tumors but, more recently, it has become evident that with a plan of active surveillance that reserves treatment for only those patients whose tumors show evidence of progression, very high disease-specific survival can be achieved. Unfortunately, the frequency of recommendation of an active surveillance strategy in the United States is low. An alternative strategy to improve prostate cancer detection is through selected biopsy of those men who are at greater risk of harboring high-grade, potentially lethal cancer. This strategy is currently possible through the use of risk assessment tools such as the Prostate Cancer Prevention Trial Risk Calculator ( www.prostate.cancer.risk.calculator.com ) as well as others. These tools can predict with considerable accuracy a man's risk of low-grade and high-grade cancer, allowing informed decision making for the patient with a goal of detection of high-risk disease. Ultimately, other biomarkers including PCA3, TMPRSS2:ERG, and [-2]proPSA will likely aid in discriminating these two types of cancer before biopsy.

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Investigating the psychological impact of active surveillance or active treatment in newly diagnosed favorable‐risk prostate cancer patients: A 9‐month longitudinal study

Psycho-Oncology ◽

10.1002/pon.5161 ◽

2019 ◽

Vol 28 (8) ◽

pp. 1743-1752 ◽

Cited By ~ 9

Author(s):

Eimear Ruane‐McAteer ◽

Sam Porter ◽

Joe O'Sullivan ◽

Martin Dempster ◽

Gillian Prue

Keyword(s):

Prostate Cancer ◽

Longitudinal Study ◽

Cancer Patients ◽

Active Surveillance ◽

Active Treatment ◽

Psychological Impact ◽

Newly Diagnosed ◽

Risk Prostate Cancer

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Further Support for Active Surveillance in the Management of Low-Volume, Low-Grade Prostate Cancer

European Urology ◽

10.1016/j.eururo.2010.09.003 ◽

2010 ◽

Vol 58 (6) ◽

pp. 836-837 ◽

Cited By ~ 2

Author(s):

Peter Albertsen

Keyword(s):

Prostate Cancer ◽

Active Surveillance ◽

Low Grade ◽

Low Volume

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How do prostate cancer patients navigate the active surveillance journey? A 3-year longitudinal study

Supportive Care in Cancer ◽

10.1007/s00520-020-05524-8 ◽

2020 ◽

Vol 29 (2) ◽

pp. 645-651 ◽

Cited By ~ 1

Author(s):

Paola Dordoni ◽

Fabio Badenchini ◽

Maria Francesca Alvisi ◽

Julia Menichetti ◽

Letizia De Luca ◽

...

Keyword(s):

Prostate Cancer ◽

Longitudinal Study ◽

Cancer Patients ◽

Active Surveillance

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Risk of more advanced cancer at surgery in African American men eligible for active surveillance.

Journal of Clinical Oncology ◽

10.1200/jco.2012.30.15_suppl.e15214 ◽

2012 ◽

Vol 30 (15_suppl) ◽

pp. e15214-e15214

Author(s):

Amirali H Salmasi ◽

Misop Han ◽

Isaac Yi Kim

Keyword(s):

Prostate Cancer ◽

African American ◽

Advanced Cancer ◽

Active Surveillance ◽

African American Men ◽

Low Grade ◽

Inclusion Criteria ◽

Medical Institutions ◽

Caucasian Men ◽

Preoperative Predictors

e15214 Background: African-American (AA) men have a higher risk for developing prostate cancer (PCa) and dying of PCa compared to Caucasian men. Active surveillance (AS) is an acceptable management for males with low volume and low grade PCa. In Caucasian men who were eligible for AS, the risk of non-organ-confined disease [NOC] at radical prostatectomy (RP) ranges between 7.8 and 10.9% (Kang et al 2011, Mufarrij et al 2010). It is unclear whether AA men with favorable risk PCa can undergo AS safely. We evaluated changes in staging and grading of PCa in a cohort of AA males that met the criteria for AS but underwent RP. Methods: Between 1997 and 2011, 1536 AA men underwent RP at either Johns Hopkins Medical Institutions or Cancer Institute of New Jersey. Pathological characteristics of patients who fulfilled the inclusion criteria under the National Cancer Institute (NCI) AS criteria were examined. NOC (ECE/SV+/LN+) and upgrading (Gleason <7 in biopsy to Gleason >6 in RP) was evaluated. We tried to identify preoperative predictors of more advanced cancer (NOC and/or upgrading). Results: We identified 212 men who underwent RP, eligible for AS based on NCI criteria. Among 212 men, 92 (37.7%) men showed NOC and/or upgrading, defined SV involvement in 5 (2.4%), ECE in 53 (25%), and increased Gleason (<7 to >6) in 69 (32%) men. Pre-operative PSA level (OR 1.2, p < 0.05) and age (OR 1.06, p < 0.01) were significantly associated with more advanced cancer. No significant association was found between BMI, tissue percentage, or positive cores with more advanced cancer. Conclusions: AS in AA with prostate cancer carries higher risk of NOC compared to non-AA population. More stringent AS entrance criteria may be necessary for AA men.

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Urinary TMPRSS2: Use of ERG and PCA3 to predict tumor volume and Gleason grade in an active surveillance cohort—Results from the Canary/EDRN Prostate Active Surveillance Study.

Journal of Clinical Oncology ◽

10.1200/jco.2012.30.5_suppl.2 ◽

2012 ◽

Vol 30 (5_suppl) ◽

pp. 2-2 ◽

Cited By ~ 2

Author(s):

Daniel W. Lin ◽

Lisa F Newcomb ◽

Elissa C Brown ◽

James D Brooks ◽

Peter Carroll ◽

...

Keyword(s):

Prostate Cancer ◽

Active Surveillance ◽

Gleason Score ◽

Tumor Volume ◽

Surveillance Study ◽

Low Grade ◽

Gleason Grade ◽

Aggressive Disease ◽

Negative Biopsy ◽

Risk Prostate Cancer

2 Background: Active surveillance is an increasing alternative for the management of low risk prostate cancer; however, there is a crucial need for better biomarkers to distinguish men with indolent versus aggressive disease. Both PCA3 and TMRPSS2-ERG (T2-ERG) are biomarkers that show promise in that they may be associated with more aggressive disease. This study examines the correlation of these biomarkers with higher volume or grade cancer in an active surveillance cohort. Methods: Post-DRE urine was collected prospectively as part of the multi-institutional Canary/EDRN Prostate Active Surveillance Study (PASS). PCA3 and T2-ERG levels were analyzed in urine collected from 401 men at study entry. Many of the men had undergone previous biopsies after initial prostate cancer diagnosis, and 20% of the urine specimens were associated with a negative serial biopsy. Biomarker scores were correlated to clinical and pathologic variables, including tumor volume - measured by percent of biopsy core involvement - and Gleason score, using non-parametric and univariate analyses. Results: Both PCA3 and T2-ERG scores were significantly associated with higher volume disease. For negative repeat biopsy, 1-10%, 11-34%, >34% positive cores, median (95% CI) PCA3 scores were 27 (24-31), 26 (22-33), 40 (29-51), 47 (26-90), p = 0.003 [Kruskal Wallis test (KW)], and median T2-ERG scores were 5 (2-8), 9 (4-14), 21 (14-40), 23 (4-115), p < 0.0001 (KW). Both PCA3 and T2-ERG scores were also significantly associated with presence of higher grade disease. For negative biopsy, Gleason 5 - 6, and Gleason >7, the median PCA3 scores were 27 (24-31), 31 (27-35), 48 (31-92), p = 0.02 (KW), and median T2-ERG scores were 5 (2-8), 14 (9-18), 29 (13-78), p = 0.001 (KW). The odds ratio for a positive biopsy versus a negative biopsy (ref) on modeling was 1.37 (1.04-1.81), p = 0.02 for PCA3 and 1.30 (1.12-1.51), p = 0.0006 for T2-ERG. Conclusions: Both PCA3 and T2-ERG appear to stratify risk, for men on active surveillance, of having aggressive cancer as defined by tumor volume or Gleason score and may have clinical applicability in selecting men with low volume/low grade disease for active surveillance.

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The Role of MRI in Prostate Cancer Active Surveillance

BioMed Research International ◽

10.1155/2014/203906 ◽

2014 ◽

Vol 2014 ◽

pp. 1-6 ◽

Cited By ~ 18

Author(s):

Linda M. Johnson ◽

Peter L. Choyke ◽

William D. Figg ◽

Baris Turkbey

Keyword(s):

Prostate Cancer ◽

Active Surveillance ◽

Treatment Strategies ◽

Low Grade ◽

Common Cancer ◽

High Incidence ◽

Aggressive Tumors ◽

Slow Growing

Prostate cancer is the most common cancer diagnosis in American men, excluding skin cancer. The clinical behavior of prostate cancer varies from low-grade, slow growing tumors to high-grade aggressive tumors that may ultimately progress to metastases and cause death. Given the high incidence of men diagnosed with prostate cancer, conservative treatment strategies such as active surveillance are critical in the management of prostate cancer to reduce therapeutic complications of radiation therapy or radical prostatectomy. In this review, we will review the role of multiparametric MRI in the selection and follow-up of patients on active surveillance.

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Comparing Perspectives of Canadian Men Diagnosed With Prostate Cancer and Health Care Professionals About Active Surveillance

Journal of Patient Experience ◽

10.1177/2374373520932735 ◽

2020 ◽

Vol 7 (6) ◽

pp. 1122-1129

Author(s):

Margaret Fitch ◽

Veronique Ouellet ◽

Kittie Pang ◽

Simone Chevalier ◽

Darrel E Drachenberg ◽

...

Keyword(s):

Prostate Cancer ◽

Health Care ◽

Decision Making ◽

Active Surveillance ◽

Health Care Professionals ◽

Critical Factor ◽

Disease Status ◽

Low Risk ◽

Management Approach ◽

Low Grade

Active surveillance (AS) has gained acceptance as a primary management approach for patients diagnosed with low-risk prostate cancer (PC). In this qualitative study, we compared perspectives between patients and health care professionals (HCP) to identify what may contribute to patient–provider discordance, influence patient decision-making, and interfere with the uptake of AS. We performed a systematic comparison of perspectives about AS reported from focus groups with men eligible for AS (7 groups, N = 52) and HCP (5 groups, N = 48) who engaged in conversations about AS with patient. We used conventional content analysis to scrutinize separately focus group transcripts and reached a consensus on similar or divergent viewpoints between them. Patients and clinicians agreed that AS was appropriate for low grade PC and understood the low-risk nature of the disease. They shared the perspective that disease status was a critical factor to pursue or discontinue AS. However, men expressed a greater emphasis on quality of life in their decisions related to AS. Patients and clinicians differed in their perspectives on the clarity, availability, and volume of information needed and offered; clinicians acknowledged variations between HCP when presenting AS, while patients were often compelled to seek additional information beyond what was provided by physicians and experienced difficulty in finding or interpreting information applicable to their situation. A greater understanding of discordant perspectives about AS between patients and HCP can help improve patient engagement and education, inform development of knowledge-based tools or aids for decision-making, and identify areas that require standardization across the clinical practice.

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