The prognostic value of PSA derivatives in favourable risk localised prostate cancer

2007 ◽  
Vol 25 (18_suppl) ◽  
pp. 5008-5008
Author(s):  
N. J. van As ◽  
M. K. Ng ◽  
A. R. Norman ◽  
R. Huddart ◽  
D. Dearnaley ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Multivariate Analysis ◽  
Disease Progression ◽  
Active Surveillance ◽  
Gleason Score ◽  
Prognostic Value ◽  
Repeat Biopsy ◽  
Clinical Variables ◽  
Psa Velocity ◽  
Total Psa

5008 Introduction: Risk stratification in localized prostate cancer is based on PSA level, Gleason score and T stage. PSA derivatives may be of additional prognostic value. We have assessed the use of PSA derivatives in the prediction of histologic disease progression on repeat biopsy in patients on active surveillance. Methods: In a prospective cohort study of active surveillance, men with untreated, low- and intermediate-risk, clinically localized prostate cancer (T1/2a, PSA < 15 ng/ml, Gleason score ≤ 3 + 4, and % positive cores ≤ 50%) had repeat octant prostate biopsies 18–24 months after diagnosis. Histologic progression was defined as primary Gleason pattern ≥ 4, or % positive cores > 50 %, or an increase in Gleason score from ≤ 6 to ≥ 7. Standard clinical variables and PSA derivatives were analysed with respect to histologic progression. Multivariate analysis was performed including all standard variables both with each PSA derivative individually, and with all PSA derivatives. Results: 175 men had repeat biopsy. Median age was 67 yrs and median initial PSA, 6.5 ng/ml. Histologic disease progression was seen in 50 (29%) cases. Factors associated with histologic progression on univariate analysis were PSA velocity (p=0.0001), PSA density (p=0.0002), free-total PSA ratio (p=0.002), maximal % core involvement (p=0.009), age (p=0.003), and initial PSA level (p=0.02). On multivariate analysis, each PSA derivative was significant, independent of standard clinical variables. On combined multivariate analysis, free-total PSA ratio (p=0.0027), PSA velocity (p=0.009), age (p=0.0057) and maximal % core involvement (p=0.011) were significant determinants of histologic progression. Conclusions: Free-total PSA ratio and PSA velocity may be useful in the subclassification of favourable-risk localized disease. Larger validation studies in active surveillance patients are warranted. No significant financial relationships to disclose.

Pathologic upgrading on confirmatory biopsy in a racially diverse group of men on active surveillance for prostate cancer.

2016 ◽  
Vol 34 (2_suppl) ◽  
pp. 142-142
Author(s):  
Allison H. Feibus ◽  
Nora M. Haney ◽  
John Boxberger ◽  
Justin Levy ◽  
Robert Scott Libby ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Active Surveillance ◽  
Gleason Score ◽  
Repeat Biopsy ◽  
Diverse Group ◽  
Racially Diverse ◽  
Clinical Variables ◽  
Increased Risk ◽  
Initial Biopsy ◽  
Multiple Variables

142 Background: To evaluate the clinical variables associated with upgrading at confirmatory biopsy among a racially-diverse group of men with prostate cancer (PCa) who elect Active Surveillance (AS). Methods: Following IRB approval, of the more than 260 men from our multi-institutional prospective AS database we identified 140 that had undergone at least 1 confirmatory biopsy since their initial diagnosis. Patients whose diagnosis was made on TURP, had any Gleason 4 on their initial biopsy or whose initial and confirmatory biopsy were more than 2 years apart were excluded. The analysis cohort included 121 men who had Gleason Score ≤ 6, clinical stage ≤ T2a and PSA ≤ 20 ng/mL. Disease upgrading on confirmatory biopsy was Gleason score ≥ 7. Multiple variables were examined as univariate and MV predictors of upgrading. Results: We identified 121 men who fit inclusion criteria, 55 (45%) African Americans (AA) and 66 non-AA (55%) with a median follow-up of 22 months. The median age was 66, median number of biopsy cores taken at diagnostic biopsy was 12 and median time interval between diagnostic and confirmatory biopsy was 12 months. On confirmatory biopsy, no evidence of disease was noted for 51 (42%) men (26 AA, 25 non-AA), 48 (40%) men (18, AA, 30 non-AA) had findings consistent with their initial biopsy and 22 men (11 AA, 11 non-AA) experienced upgrading at repeat biopsy. Of the 22 (18%) men who were upgraded, 18 (8 AA, 10 non-AA) upgraded to a Gleason score of 7, 3 (2 AA, 1 non-AA) were upgraded to a Gleason score of 8 and 1 (AA) had a Gleason score of 9. In univariate analysis AA race was associated with a greater number of positive cores (p = 0.04) and greater total prostate volume (p = 0.03) at confirmatory biopsy. Multivariate analysis was performed and none of the clinical variables examined (race, age, BMI, PSA, volume, PSAD, number of positive cores, total number of cores, percentage of positive cores, time between biopsies) were associated with upgrading on repeat biopsy. Conclusions: Our findings suggest that race is not associated with an increased risk of upgrading at confirmatory biopsy. AA with low-risk PCa are reasonable candidates for inclusion in most AS protocols and should not be excluded based on race alone.

Evaluation of the prostate health index (phi) as a novel biomarker in active surveillance of prostate cancer.

2014 ◽  
Vol 32 (4_suppl) ◽  
pp. 81-81
Author(s):  
Andrew Eichholz ◽  
Frank McCarthy ◽  
Nening Dennis ◽  
Karen Thomas ◽  
Tim Howlett ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Active Surveillance ◽  
Repeat Biopsy ◽  
Time To Treatment ◽  
Prostate Health Index ◽  
Risk Prostate Cancer ◽  
Psa Velocity ◽  
Total Psa ◽  
Prostate Health

81 Background: Phi is calculated from serum PSA, free/total (f/t) PSA and [-2]proPSA using the Beckman Coulter assay kit, and has been approved for use in patient selection for diagnostic prostate biopsy. We hypothesized that phi might also predict outcome of active surveillance. Methods: From 2002, we have done a prospective cohort study of active surveillance for men with T1/2, Gleason <= 3+4, PSA < 15ng/ml prostate cancer. Serum was banked at baseline. Monitoring included 6 monthly PSA and 2-yearly repeat biopsy. Treatment was indicated for PSA velocity > 1ng/ml/yr or Gleason >= 4+3 on repeat biopsy. We analyzed baseline phi with respect to time to treatment. A multivariate model was fitted using total PSA, PSA velocity, PSA density, Gleason score, % biopsy cores positive, T stage, and maximum % cancer in any biopsy core. The fit of this model was then compared with the addition of % f/t PSA and phi. Results: 370 patients were evaluable with a median follow-up of 5 years. The table shows the association between baseline phiand time to treatment. On multivariate analysis, the model with % f/t PSA was a significant improvement over base model (change in fit 41.1, p<0.001), and the model with % f/t PSA and phi was a significantly better fit than % f/t PSA alone (change in fit 11.1, p=0.001). Conclusions: In men with favorable risk prostate cancer, phi at diagnosis was a significant predictor of the outcome of active surveillance. The data require validation, but suggest that active surveillance is particularly attractive to men with a low phi. [Table: see text]

Baseline Urinary Phytoestrogen Levels and the Natural History of Untreated, Localised Prostate Cancer in a British Population

2008 ◽  
Vol 23 (3) ◽  
pp. 192-197 ◽  
Author(s):  
R. Venkitaraman ◽  
K. Thomas ◽  
P. Grace ◽  
D. Dearnaley ◽  
A. Horwich ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Disease Progression ◽  
Repeat Biopsy ◽  
Prospective Clinical Study ◽  
Gleason Grade ◽  
Prostate Biopsies ◽  
Urinary Levels ◽  
Liquid Chromatography Tandem Mass ◽  
History Of ◽  
Psa Velocity

Aim To determine whether urinary concentrations of phytoestrogens are associated with the rate of disease progression in men with untreated, localised prostate cancer. Patients and methods Patients with untreated, localised prostatic adenocarcinoma on a prospective clinical study of active surveillance had urine samples collected at baseline. Patients underwent monitoring with serial PSA levels and repeat octant prostate biopsies. Disease progression was defined as either adverse histology on repeat biopsy (primary Gleason grade ≥4, or >50% positive cores) or radical treatment for PSA velocity >1 ng/mL/year. Time to disease progression was analysed with respect to baseline urinary levels of genistein, enterolactone, daidzein and equol, assayed using liquid chromatography/tandem mass spectrometry. Results 191 patients were evaluable, with a median follow-up of 2.5 years. 71 patients experienced disease progression. No significant association was seen between time to disease progression and baseline urinary levels of daidzein (p=0.85), genistein (p=0.81), enterolactone (p=0.085) or equol (p=0.33). No significant association was seen between adverse histology on repeat biopsy and urinary levels of either daidzein (p=0.85), genistein (p=0.58), enterolactone (p=0.88) or equol (p=0.71). There was no significant correlation between PSA velocity and urinary levels of daidzein (p=0.90), genistein (p=0.98), enterolactone (p=0.10) or equol (p=0.60). Conclusion These data do not support the hypothesis that phytoestrogens prevent disease progression in men with localised prostate cancer.

1749: Correlation between Initial total PSA and PSA Velocity in men with and without Biopsy-Proven Prostate Cancer

2007 ◽  
Vol 177 (4S) ◽  
pp. 581-581
Author(s):  
Jasmin Bektic ◽  
Alexandre E. Pelzer ◽  
Georg Schaefer ◽  
Georg Bartsch ◽  
Wolfgang Horninger ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Psa Velocity ◽  
Total Psa

Adverse Disease Features in Gleason Score 3 + 4 “Favorable Intermediate-Risk” Prostate Cancer: Implications for Active Surveillance

2017 ◽  
Vol 72 (3) ◽  
pp. 442-447 ◽  
Author(s):  
Alessandro Morlacco ◽  
John C. Cheville ◽  
Laureano J. Rangel ◽  
Derek J. Gearman ◽  
R. Jeffrey Karnes
Keyword(s):  
Prostate Cancer ◽  
Active Surveillance ◽  
Gleason Score ◽  
Intermediate Risk ◽  
Risk Prostate Cancer

A phase II randomized controlled trial of exercise on biochemical progression in men with prostate cancer on active surveillance.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. 5080-5080
Author(s):  
Dong-Woo Kang ◽  
Adrian S. Fairey ◽  
Normand G. Boulé ◽  
Catherine J. Field ◽  
Stephanie A. Wharton ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Randomized Controlled Trial ◽  
Physical Fitness ◽  
Disease Progression ◽  
Active Surveillance ◽  
Cardiorespiratory Fitness ◽  
Controlled Trial ◽  
Mean Difference ◽  
Randomized Controlled ◽  
Biochemical Progression

5080 Background: Men with prostate cancer (PCa) undergoing active surveillance (AS) are at increased risks of cardiovascular death and disease progression. Any intervention that can address these issues during AS would be highly beneficial. Clinical and preclinical studies have demonstrated the benefits of exercise to improve cardiovascular health in cancer patients and suggested the potential role of exercise in suppressing PCa progression in men with PCa undergoing AS. Therefore, the purpose of this study was to investigate the effects of exercise on cardiorespiratory fitness and biochemical progress of PCa in men with PCa on AS. Methods: The Exercise During Active Surveillance for Prostate Cancer (ERASE) Trial was a single-centre, two-armed, randomized controlled trial in Edmonton, Canada. 52 men with localized PCa who were undergoing AS were randomized to high-intensity interval training (HIIT; n = 26) or usual care (UC; n = 26). The HIIT group performed thrice-weekly, supervised, aerobic HIIT on a treadmill at 85-95% of peak cardiorespiratory fitness (VO2peak) for 12 weeks. The primary outcome was VO2peak, and the secondary and exploratory outcomes included biochemical progression of PCa (prostate-specific antigen [PSA]), PSA kinetics, and growth of prostate cancer cell line LNCaP. Results: 46/52 participants (88%) completed the postintervention VO2peak assessment and adherence to HIIT was 96%. Compared to UC, HIIT significantly improved VO2peak (adjusted between-group mean difference, 1.6 ml·kg-1·min-1; 95% confidence interval [CI], 0.3 to 2.9; p= 0.014). HIIT also significantly reduced PSA level (adjusted between-group mean difference, -1.1 ug/L; 95% CI, -2.1 to 0.0; p= 0.043) and PSA velocity ( p= 0.040), and suppressed LNCaP cell growth ( p =0.024). No significant differences were found in PSA doubling time ( p= 0.10) and testosterone ( p= 0.24). Conclusions: The ERASE Trial is the first randomized controlled trial to demonstrate the impact of HIIT exercise for improving physical fitness and inhibiting biochemical progression of PCa in men with localized PCa on AS. Our findings suggest that supervised aerobic HIIT may be a promising intervention in this clinical setting. Larger-scale randomized controlled trials are warranted to determine if improvements in physical fitness and PCa-related markers translate into improved long-term clinical outcomes in these men such as disease progression, receipt of radical treatments, posttreatment complications, and survival. Clinical trial information: NCT03203460.

scholarly journals Exercise duRing Active Surveillance for prostatE cancer—the ERASE trial: a study protocol of a phase II randomised controlled trial

BMJ Open ◽  
2019 ◽  
Vol 9 (7) ◽  
pp. e026438 ◽  
Author(s):  
Dong-Woo Kang ◽  
Adrian S Fairey ◽  
Normand G Boulé ◽  
Catherine J Field ◽  
Kerry S Courneya
Keyword(s):  
Prostate Cancer ◽  
Randomised Controlled Trial ◽  
Disease Progression ◽  
Active Surveillance ◽  
Cancer Progression ◽  
Phase Ii ◽  
Controlled Trial ◽  
Exercise Group ◽  
Fear Of Cancer ◽  
Randomised Controlled

IntroductionActive surveillance (AS) is the preferred primary treatment strategy for men with low-risk clinically localised prostate cancer (PCa); however, the majority of these men still receive radical treatment within 10 years due to disease progression and/or fear of cancer progression. Interventions designed to suppress tumour growth, mitigate fear of cancer progression and precondition men for impending radical treatments are an unmet clinical need. Exercise has been shown to delay the progression of prostate tumours in animal models, improve physical and functional health and manage psychological outcomes in cancer patients; however, these outcomes have not been demonstrated in PCa patients undergoing AS.Methods and analysisThis phase II randomised controlled trial will randomise 66 men undergoing AS to either an exercise group or a usual care group. The exercise group will perform a 12-week, supervised, high-intensity interval training programme, consisting of 3 sessions/week for 28–40 min/session. The primary outcome will be cardiorespiratory fitness. Secondary outcomes will include immunosurveillance and cancer-related biomarkers, psychosocial outcomes including fear of cancer progression and quality of life and physical function. Exploratory outcomes will include clinical indicators of disease progression. The trial has 80% power to detect a significant between-group difference in VO2peakof 3.5 mL/kg/min with a two-tailed alpha level <0.05 and a 10% dropout rate.Ethics and disseminationThe study has received full ethical approval from the Health Research Ethics Board of Alberta – Cancer Committee (Protocol Number: HREBA.CC-17–0248). The findings of the study will be disseminated through public and scientific channels.Trial registration numberNCT03203460; Pre-results.

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