scholarly journals The Role of MRI in Prostate Cancer Active Surveillance

2014 ◽  
Vol 2014 ◽  
pp. 1-6 ◽  
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.

scholarly journals Role of IGF2 in the Study of Development and Evolution of Prostate Cancer

2022 ◽  
Vol 12 ◽  
Author(s):  
P. Porras-Quesada ◽  
JM. González-Cabezuelo ◽  
V. Sánchez-Conde ◽  
I. Puche-Sanz ◽  
V. Arenas-Rodríguez ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Active Surveillance ◽  
Biomedical Research ◽  
Current Medical ◽  
Significant Problem ◽  
Non Invasive ◽  
Relevant Role ◽  
Development And Evolution

Prostate Cancer (PC) is commonly known as one of the most frequent tumors among males. A significant problem of this tumor is that in early stages most of the cases course as indolent forms, so an active surveillance will anticipate the appearance of aggressive stages. One of the main strategies in medical and biomedical research is to find non-invasive biomarkers for improving monitoring and performing a more precise follow-up of diseases like PC. Here we report the relevant role of IGF2 and miR-93-5p as non-invasive biomarker for PC. This event could improve current medical strategies in PC.

Latest Evidence on the Role of Multiparametric Magnetic Resonance Imaging in Active Surveillance for Insignificant Prostate Cancer: A Systematic Review

2018 ◽  
Vol 18 (7) ◽  
pp. 925-930 ◽  
Author(s):  
Francesco Cantiello ◽  
Stefano Manno ◽  
Giorgio I. Russo ◽  
Sebastiano Cimino ◽  
Salvatore Privitera ◽  
...  
Keyword(s):  
Magnetic Resonance Imaging ◽  
Prostate Cancer ◽  
Systematic Review ◽  
Magnetic Resonance ◽  
Active Surveillance ◽  
Resonance Imaging ◽  
Multiparametric Magnetic Resonance Imaging ◽  
Clinically Significant

Objective: Multiparametric Magnetic Resonance Imaging (mpMRI) has become a very useful tool in the management of PCa. Particularly, there is a great interest in using mpMRI for men on Active Surveillance (AS) for low risk PCa. The aim of this systematic review was to critically review the latest literature concerning the role of mpMRI in this clinical setting, underlying current strengths and weakness. Evidence Acquisition: A comprehensive literature research for English-language original and review articles was carried out using the National Center for Biotechnology Information PubMed database with the aim to identify studies pertaining to mpMRI for AS in low risk PCa patients. The following search terms were used: active surveillance, prostate cancer and multiparametric magnetic resonance imaging. Evidence Synthesis: Data from 28 recent original studies and reviews were reviewed. We only considered studies on the use of mpMRI in selecting AS patients and during AS follow-up, in order to solve two important questions: -Can mpMRI have a role in improving the detection of clinically significant disease, better selecting AS patients? -Can mpMRI identify the progression of disease and, consequently, be used during AS follow-up? Conclusions: mpMRI is useful to better select the ideal candidates to AS and to monitor them during follow-up. However, despite many advantages, there are yet important limitations to detect all clinically significant PCa and to better define mpMRI-radiological progression during AS. Further larger prospective studies are needed to definitively solve these important problems.

Outcome of leiomyosarcoma of bone: A single center experience.

2013 ◽  
Vol 31 (15_suppl) ◽  
pp. e21502-e21502
Author(s):  
Rajeev Rajendra ◽  
Seth Pollack ◽  
Eve T. Rodler ◽  
Ernest U. Conrad ◽  
Darin J Davidson ◽  
...  
Keyword(s):  
Local Recurrence ◽  
Neoadjuvant Chemotherapy ◽  
Surgical Resection ◽  
Treatment Strategies ◽  
Recurrence Time ◽  
Low Grade ◽  
High Grade ◽  
Response To Chemotherapy

e21502 Background: Leiomyosarcoma (LMS) of bone is a very rare sarcoma subtype. These tumors are managed akin to osteosarcoma, with neoadjuvant chemotherapy followed by surgery. The precise role of chemotherapy remains to be defined. Methods: Patients treated with primary bone LMS at the University of Washington between 2002 and 2012 were included. Patients with high grade tumors were treated with neoadjuvant chemotherapy and surgery; whereas those with low grade tumors were treated with surgical resection alone. Chemotherapy consisted of doxorubicin and ifosfamide x 2 cycles. Treatment details included: initial treatment (surgery versus chemo), surgical and pathological margins, and timing of chemotherapy. Follow-up data included: time to local recurrence, time to metastasis, time to last follow up if alive, or time to death. Results: Ten patients were identified, 4 male and 6 female. Median age at diagnosis: 52 years (range 29 - 91). The primary site was the distal femur in 5 patients, and the hemipelvis, acetabulum, proximal femur, distal clavicle and mid-shaft of femur in 1 patient each. Median tumor size at diagnosis was 8 cm. Five were high-grade tumors; 3 were intermediate and 2 were low grade. Four of 10 patients received neoadjuvant chemotherapy, with the following histological response; 70%, 30%, 15% and <5%. None of these patients had a dimensional radiological response to chemotherapy. Of the patients treated with surgery alone, one developed a local recurrence and another developed metastatic disease. Of the patients treated with chemotherapy and surgery, 1 died from an unrelated cause. Median follow-up was 9 months (range 0 - 83). Median DFS was 9 months (range 0 - 83). OS has not yet been reached. Conclusions: Surgical resection remains the mainstay of management of LMS of bone. The role of neoadjuvant chemotherapy requires further evaluation. Larger collaborative studies and biomarker analyses are essential to evaluate optimal treatment strategies for this rare disease.

Active surveillance of prostate cancer in African-Americans during the MRI era.

2018 ◽  
Vol 36 (6_suppl) ◽  
pp. 108-108
Author(s):  
Jonathan Bloom ◽  
Samuel Gold ◽  
Graham R. Hale ◽  
Kareem Rayn ◽  
Vladimir Valera ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Active Surveillance ◽  
Aggressive Disease ◽  
Time Period ◽  
Risk Prostate Cancer ◽  
Risk Of Progression ◽  
Low Risk Prostate Cancer ◽  
Primary Management

108 Background: Many patients with low-risk prostate cancer are encouraged by their physicians to pursue active surveillance (AS). AS has increasingly been utilized, however there remains anxiety by patients and their physicians that more aggressive disease will be missed and allowed to progress. African-American (AA) patients may present with more aggressive disease and higher rates of upgrading at the time of radical prostatectomy. Due to these factors, physicians may be hesitant to recommend AS to AA patients. We examined the role of AS in these patients in the era of MRI targeted biopsies. Methods: A prospectively maintained database was queried for all patients who underwent an MRI guided fusion biopsy from 2007 to 2016 and chose AS as their primary management strategy. Patents with Gleason Group (GG) 1 or 2 were eligible. Patients were then followed with yearly PSA, exam, MRI and biopsy if warranted. MRI Fusion biopsies were reviewed to determine any GG progression. Results: A total of 19 AA and 143 non-AA patients were reviewed with median follow up times of 31.63 (15.42 -89.50) and 30.87 (3.45 – 99.85) months, respectively. AA and non-AA patients had similar baseline PSA values (6.08 ± 2.93 vs. 5.89 ± 4.23, p = 0.85), proportion of GG 1 (15.89% vs 21.68%, p = 0.55) and PSA density (0.103 ± 0.041 vs. 0.123 ± 0.041, p = 0.36. However, AA patients did present at an earlier age (58.89 ± 6.64 vs. 63.69 ± 6.64, p = 0.004). A total of 8/19 (42.1%) AA and 46/143 (32.2%) non-AA had GG upgrading while on AS, p = 0.34. The median time until progression for AA and non-AA patients was 60.76 and 77.42 months, p = 0.68. Conclusions: In our study, AA men did begin AS at an earlier age than non-AA men. While both groups had statistically similar rates of progression, the relative risk of progression was higher in the AA cohort during this time period. Therefore, in the era of MRI and fusion biopsies we are better able to detect upgrading and somewhat mitigate the the risks associated with upgrading during AS irrespective of race but larger studies are needed to determine whether there are meaningful differences in the rates of progression between AA and non-AA men. This research was supported by the Intramural Research Program of the National Cancer Institute, NIH.

scholarly journals Active Surveillance in Prostate Cancer: Role of Available Biomarkers in Daily Practice

2021 ◽  
Vol 22 (12) ◽  
pp. 6266
Author(s):  
Belén Pastor-Navarro ◽  
José Rubio-Briones ◽  
Ángel Borque-Fernando ◽  
Luis M. Esteban ◽  
Jose Luis Dominguez-Escrig ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Active Surveillance ◽  
Daily Practice ◽  
Controversial Issues ◽  
Inclusion Criteria ◽  
Clinical Progression ◽  
Diagnostic Ability ◽  
Urine Biomarkers

Prostate cancer (PCa) is the most commonly diagnosed cancer in men. The diagnosis is currently based on PSA levels, which are associated with overdiagnosis and overtreatment. Moreover, most PCas are localized tumours; hence, many patients with low-/very low-risk PCa could benefit from active surveillance (AS) programs instead of more aggressive, active treatments. Heterogeneity within inclusion criteria and follow-up strategies are the main controversial issues that AS presently faces. Many biomarkers are currently under investigation in this setting; however, none has yet demonstrated enough diagnostic ability as an independent predictor of pathological or clinical progression. This work aims to review the currently available literature on tissue, blood and urine biomarkers validated in clinical practice for the management of AS patients.

scholarly journals Active Surveillance for Localized Prostate Cancer – Current Practices and Recommendations

2010 ◽  
Vol 10 ◽  
pp. 2352-2361 ◽  
Author(s):  
Jennifer N. Wu ◽  
Marc A. Dall'Era
Keyword(s):  
Prostate Cancer ◽  
Active Surveillance ◽  
Watchful Waiting ◽  
Low Grade ◽  
Prostate Cancer Treatment ◽  
Diagnostic Practices ◽  
High Prevalence ◽  
Localized Disease ◽  
Selective Therapy

Prostate cancer is now the most commonly diagnosed solid tumor in American men, due in part to widespread screening and aggressive diagnostic practices. Prostate cancer autopsy studies show the uniquely high prevalence rates of small, indolent tumors in men dying of other causes. These findings have led to increased concern for the overdetection and overtreatment of prostate cancer. Active surveillance for prostate cancer allows one to limit prostate cancer treatment with concomitant risks of treatment-related morbidity to the men who will benefit the most from aggressive therapies. Several tools have been developed in treated and surveyed men to assist physicians in selecting men with potentially indolent tumors amenable to active surveillance. Recent published results describe institutional experiences with active surveillance and delayed selective therapy for men with low-grade, early prostate cancer. Although median follow-up from these studies is relatively short, the outcomes appear favorable. Data from these reports provide information for selecting men for this approach, as well as for following them over time and determining triggers for further intervention. Ongoing clinical trials with watchful waiting and active surveillance for prostate cancer will ultimately provide improved evidence for managing early, localized disease.

scholarly journals Guy’s and St Thomas NHS Foundation active surveillance prostate cancer cohort: a characterisation of a prostate cancer active surveillance database

BMC Cancer ◽  
2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Salonee Shah ◽  
Kerri Beckmann ◽  
Mieke Van Hemelrijck ◽  
Ben Challacombe ◽  
Rick Popert ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Active Surveillance ◽  
Specific Antigen ◽  
Future Research ◽  
Low Grade ◽  
Intermediate Risk ◽  
Psa Testing ◽  
Diagnostic Characteristics ◽  
Diagnostic Biopsy

Abstract Background The routine clinical use of serum prostatic specific antigen (PSA) testing has allowed earlier detection of low-grade prostate cancer (PCa) with more favourable characteristics, leading to increased acceptance of management by active surveillance (AS). AS aims to avoid over treatment in men with low and intermediate-risk PCa and multiple governing bodies have described several AS protocols. This study provides a descriptive profile of the Guy’s and St Thomas NHS Foundation Trust (GSTT) AS cohort as a platform for future research in AS pathways in PCa. Methods Demographic and baseline characteristics were retrospectively collected in a database for patients at the GSTT AS clinic with prospective collection of follow-up data from 2012. Seven hundred eighty-eight men being monitored at GSTT with histologically confirmed intermediate-risk PCa, at least 1 follow-up appointment and diagnostic characteristics consistent with AS criteria were included in the profile. Descriptive statistics, Kaplan-Meier survival curves and multivariable Cox proportion hazards regression models were used to characterize the cohort. Discussion A relatively large proportion of the cohort includes men of African/Afro-Caribbean descent (22%). More frequent use of magnetic resonance imaging and trans-perineal biopsies at diagnosis was observed among patients diagnosed after 2012. Those who underwent trans-rectal ultrasound diagnostic biopsy received their first surveillance biopsy 20 months earlier than those who underwent trans-perineal diagnostic biopsy. At 3 years, 76.1% men remained treatment free. Predictors of treatment progression included Gleason score 3 + 4 (Hazard ratio (HR): 2.41, 95% Confidence interval (CI): 1.79–3.26) and more than 2 positive cores taken at biopsy (HR: 2.65, CI: 1.94–3.62). A decreased risk of progressing to treatment was seen among men diagnosed after 2012 (HR: 0.72, CI: 0.53–0.98). Conclusion An organised biopsy surveillance approach, via two different AS pathways according to the patient’s diagnostic method, can be seen within the GSTT cohort. Risk of patients progressing to treatment has decreased in the period since 2012 compared with the prior period with more than half of the cohort remaining treatment free at 5 years, highlighting that the fundamental aims of AS at GSTT are being met. Thus, this cohort is a good resource to investigate the AS treatment pathway.

scholarly journals PD55-03 THE ROLE OF MRI AND FUSION BIOPSY IN THE INITIAL DIAGNOSIS AND FOLLOW-UP OF PATIENTS UNDERGOING ACTIVE SURVEILLANCE OF PROSTATE CANCER

2019 ◽  
Vol 201 (Supplement 4) ◽  
Author(s):  
Jonathan B. Bloom* ◽  
Sam A. Gold ◽  
Graham R. Hale ◽  
Amir H. Lebastachi ◽  
Michael Ahdoot ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Active Surveillance ◽  
Initial Diagnosis ◽  
Fusion Biopsy
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