Active surveillance for early stage prostate cancer: What do men and their partners think?

2016 ◽  
Vol 34 (3_suppl) ◽  
pp. 95-95
Author(s):  
Jinping Xu ◽  
Arun Mallapareddi ◽  
Julie Ruterbusch ◽  
Elyse Reamer ◽  
Susan Eggly
Keyword(s):  
Prostate Cancer ◽  
Focus Groups ◽  
Active Surveillance ◽  
Early Stage ◽  
Treatment Decision ◽  
Low Risk ◽  
Physical And Mental Health ◽  
Current Function ◽  
Physician Trust ◽  
Qualitative Thematic Analysis

95 Background: Despite growing recognition over the last decade that active surveillance (AS) is a reasonable management option for men diagnosed with localized prostate cancer (LPC), only a minority of men choose AS. This study examines the conceptualizations, experiences, and reasons for choosing AS among men with LPC and their partners. Methods: We conducted three focus groups with men with LPC who had chosen AS (7 black, 5 white) and two focus groups with their partners (all women, 2 black, 4 white). Men were identified from a cancer registry or from an academic urologists’ practice. Focus groups were video/audio recorded, transcribed and analyzed using qualitative thematic analysis. Results: Men’s median time on AS was 18 months (range 6-72) and median age was 61 years (range 47-71). Men used many different terms (mostly “wait and see”) to describe similar AS protocols. AS was seen as delaying unnecessary treatment and keeping current function with curable treatment available later if needed. Black men mentioned concerns that some physicians profit by providing unnecessary treatments. Reasons for choosing AS included seeing their cancer as “small” or “low-risk” and trusting their physician’s advice/monitoring, despite reported concerns about PSA being an unreliable test and painful biopsies. Men recognized, but were comfortable with, the small but real threat their cancer could grow. Men found they had to justify their choice to other family members, even when their partners were supportive. Partners saw themselves as very involved and influential in the treatment decision. They were comfortable with AS because of their trust in physicians. Partners believed they know their husband’s physical and mental health better than the men themselves. Conclusions: Physician trust and description of the cancer as low-risk were the most cited reasons for adopting AS. Emphasizing the low-risk nature of the cancer and enhancing physician trust may increase the acceptability of AS.

scholarly journals Active surveillance for low-risk localized prostate cancer: what do men and their partners think?

2016 ◽  
Vol 34 (1) ◽  
pp. 90-97 ◽  
Author(s):  
Arun Mallapareddi ◽  
Julie Ruterbusch ◽  
Elyse Reamer ◽  
Susan Eggly ◽  
Jinping Xu
Keyword(s):  
Prostate Cancer ◽  
Active Surveillance ◽  
Cancer Progression ◽  
Specific Antigen ◽  
Treatment Decision ◽  
Low Risk ◽  
Localized Prostate Cancer ◽  
Low Grade ◽  
Management Option ◽  
Prostate Biopsies

Abstract Background. Active surveillance (AS) is recognized as a reasonable treatment option for low-risk localized prostate cancer (LPC) but continues to be chosen by a minority of men. To date, limited data are available regarding reasons why men with low-risk LPC adopt AS. Purpose. The aim of this study is to better understand conceptualizations, experiences and reasons why men with low-risk LPC and their partners adopt AS. Methods. We conducted five focus groups (FGs), three among men with low-risk LPC who had chosen AS and two with their partners. FGs were video/audio recorded, transcribed and analysed using qualitative thematic analysis. Results. A total of 12 men and 6 partners (all women) participated in FG discussions. The most common reasons for choosing AS were seeing the LPC as ‘small’ or ‘low grade’ without need for immediate treatment and trusting their physician’s AS recommendation. The most common concerns about AS were perceived unreliability of prostate specific antigen, pain associated with prostate biopsies and potential cancer progression. Partners saw themselves as very involved in their husbands’ treatment decision-making process, more than men acknowledged them to be. Multiple terms including ‘watchful waiting’ were used interchangeably with AS. There appeared to be a lack of understanding that AS is not simply ‘doing nothing’ but is actually a recognized management option for low-risk LPC. Conclusions. Emphasizing the low risk of a man’s LPC and enhancing physician trust may increase acceptability of AS. Standardizing terminology and presenting AS as a reasonable and recognized management option may also help increase its adoption.

Assessment of 2,000 patients presenting to a multidisciplinary prostate cancer clinic in the United Kingdom.

2019 ◽  
Vol 37 (15_suppl) ◽  
pp. 5077-5077
Author(s):  
Pandora Rudd ◽  
John Hines ◽  
Eleanor Watkins ◽  
Thomas Powles ◽  
Karen Tipples
Keyword(s):  
Prostate Cancer ◽  
High Risk ◽  
Disease Severity ◽  
Active Surveillance ◽  
Group Treatment ◽  
Treatment Decision ◽  
Treatment Decisions ◽  
Treatment Choice ◽  
Low Risk ◽  
High Risk Disease

5077 Background: Multidisciplinary clinics (MDCs) involving both oncologists and urologists are recommended for managing radical prostate cancer patients. The effectiveness of MDCs in arriving at best treatment decisions is unknown. We analysed patient characteristics and management decisions over 8 years in a MDC at Bart’s Hospital, London. Methods: Clinical data were collected in real time and analysed retrospectively, including demographics, tumour stage and grade, D’amico risk group, treatment choice and first clinician seen. We compared variables in 1000 consecutive patients presenting between 2011-2015 (cohort A) to 1000 patients presenting 2016-18 (cohort B) to investigate trends over time. Results: 2000 patients were included, age 65.2 ± 8.6 years and 65.9 ± 9.1 years (p=0.08), with presenting PSA 9.0 (6.3-14.4) and 9.2 (6.4-15.0) ng/ml (p=0.36), in cohort A and B respectively. Disease severity and initial treatment decision are shown in the table. In low risk disease, 126 (75%) patients had active surveillance in cohort A, and 158 (90%) in cohort B (p=0.0003). In high risk disease, 202 (59%) patients had radiotherapy compared to 194 (50%) in cohort B (p=0.011). In cohort B, 127 (39%) patients seeing oncology first had radiotherapy compared to 143 (25%) patients who saw urology first (p<0.0001). 76 (23%) and 154 (27%) patients had surgery, that saw oncology and urology first, respectively (p=0.11). Conclusions: In 2000 patients presenting to a prostate MDC over 8 years, active surveillance in low risk disease increased, radiotherapy in high risk disease reduced, and the proportion undergoing surgery was unchanged. The initial clinician seen influenced treatment choice; having both specialists in the same consultation may improve consistency of treatment decisions. Disease severity and treatment choice before and after 2016. [Table: see text]

Active Surveillance for Low-risk Prostate Cancer: Are All Criteria Similar?

2018 ◽  
Vol 18 (7) ◽  
pp. 958-963
Author(s):  
Sebastiano Cimino ◽  
Salvatore Privitera ◽  
Vincenzo Favilla ◽  
Francesco Cantiello ◽  
Stefano Manno ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Life Expectancy ◽  
Active Surveillance ◽  
English Language ◽  
Early Stage ◽  
Meta Analysis ◽  
Low Risk ◽  
Intermediate Risk ◽  
Monitoring Methods ◽  
Deferred Treatment

Background: Active Surveillance (AS) is a therapeutic strategy for early-stage Prostate Cancer (PCa) conceived to balance early detection of aggressive disease and overtreatment of indolent tumor. Several active surveillance protocols have been published over the years, however the risk of misclassification still exist. In this review, we revised the current criteria of AS and evaluated the characteristics of potential risk factors of misclassification or deferred treatment. Methods: We did a systematic search of the MEDLINE database, from 1993 to May 2015, according to Preferred Reporting Items for Systematic Reviews and Meta-analysis statement guidelines and limited to the English language. The search terms used included “prostate cancer” and “active surveillance” and “criteria. We have excluded from the study reviews and editorial comments as well as multiple papers from the same data sets. Results: Although the follow-up of reported studies was a quite short compared to the duration of the disease, the data are sufficient to conclude that active surveillance should be offered to men with low-risk disease and to men with intermediate risk and poor life expectancy. The present challenge, in fact, is to differentiate the clinically silent disease from the unfavorable course by identifying the right timing for any deferred treatment. This is made particularly difficult by the absence of randomized controlled trials directly comparing different AS monitoring methods. Conclusion: As summarized in this review, it is still difficult to select patients eligible for active surveillance and differentiate them from those that should move to active treatment. From the data, currently available in the literature, however, it is possible to recommend active surveillance to men with low-risk disease and to men with intermediate-risk disease but with short life expectancy.

scholarly journals Outcomes of Active Surveillance for Men With Intermediate-Risk Prostate Cancer

2011 ◽  
Vol 29 (2) ◽  
pp. 228-234 ◽  
Author(s):  
Matthew R. Cooperberg ◽  
Janet E. Cowan ◽  
Joan F. Hilton ◽  
Adam C. Reese ◽  
Harras B. Zaid ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
San Francisco ◽  
Active Surveillance ◽  
Active Treatment ◽  
Early Stage ◽  
Specific Antigen ◽  
Low Risk ◽  
Gleason Grade ◽  
Intermediate Risk ◽  
Positive Biopsy

Purpose Active surveillance (AS) is an option for the initial management of early-stage prostate cancer. Current risk stratification schema identify patients with low-risk disease who are presumed to be most suitable for AS. However, some men with higher risk disease also elect AS; outcomes for such men have not been widely reported. Patients and Methods Men managed with AS at University of California, San Francisco, were classified as low- or intermediate-risk based on serum prostate-specific antigen (PSA), Gleason grade, extent of biopsy involvement, and T stage. Clinical and demographic characteristics, and progression in terms of Gleason score, PSA kinetics, and active treatment were compared between men with low- and intermediate-risk tumors. Results Compared to men with low-risk tumors, those with intermediate-risk tumors were older (mean, 64.9 v 62.3 years) with higher mean PSA values (10.9 v 5.1 ng/mL), and more tumor involvement (mean, 20.4% v 15.3% positive biopsy cores; all P < .01). Within 4 years of the first positive biopsy, the clinical risk group did not differ in terms of the proportions experiencing progression-free survival, (low [54%] v intermediate [61%]; log-rank P = .22) or the proportions who underwent active treatment (low [30%] v intermediate [35%]; log-rank P = .88). Among men undergoing surgery, none were node positive and none had biochemical recurrence within 3 years. Conclusion Selected men with intermediate-risk features be appropriate candidates for AS, and are not necessarily more likely to progress. AS for these men may provide an opportunity to further reduce overtreatment of disease that is unlikely to progress to advanced cancer.

scholarly journals Perceptions of partial gland ablation for prostate cancer among men on active surveillance: a qualitative study

2021 ◽  
Vol 3 (1) ◽  
pp. e000068
Author(s):  
Sonia Hur ◽  
Michael Tzeng ◽  
Eliza Cricco-Lizza ◽  
Spyridon Basourakos ◽  
Miko Yu ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Decision Making ◽  
Qualitative Study ◽  
Active Surveillance ◽  
Treatment Modality ◽  
Tertiary Care ◽  
Low Risk ◽  
Intermediate Risk ◽  
Perceptions And Attitudes ◽  
Partial Gland Ablation

ObjectivesPartial gland ablation (PGA) therapy is an emerging treatment modality that targets specific areas of biopsy-proven prostate cancer (PCa) to minimize treatment-related morbidity by sparing benign prostate. This qualitative study aims to explore and characterize perceptions and attitudes toward PGA in men with very-low-risk, low-risk, and favorable intermediate-risk PCa on active surveillance (AS).Design92 men diagnosed with very-low-risk, low-risk, and favorable intermediate-risk PCa on AS were invited to participate in semistructured telephone interviews on PGA.SettingSingle tertiary care center located in New York City.Participants20 men with very-low-risk, low-risk, and favorable intermediate-risk PCa on AS participated in the interviews.Main outcome measuresEmerging themes on perceptions and attitudes toward PGA were developed from transcripts inductively coded and analyzed under standardized methodology.ResultsFour themes were derived from 20 interviews that represent the primary considerations in treatment decision-making: (1) the feeling of psychological safety associated with low-risk disease; (2) preference for minimally invasive treatments; (3) the central role of the physician; (4) and the pursuit of treatment options that align with disease severity. Eleven men (55%) expressed interest in pursuing PGA only if their cancer were to progress, while nine men (45%) expressed interest at the current moment.ConclusionsAlthough an emerging treatment modality, patients were broadly accepting of PGA for PCa, with men primarily debating the risks versus benefits of proactively treating low-risk disease. Additional research on men’s preferences and attitudes toward PGA will further guide counseling and shared decision-making for PGA.

scholarly journals Assessment of PSIM (Prostatic Systemic Inflammatory Markers) Score in Predicting Pathologic Features at Robotic Radical Prostatectomy in Patients with Low-Risk Prostate Cancer Who Met the Inclusion Criteria for Active Surveillance

Diagnostics ◽  
2021 ◽  
Vol 11 (2) ◽  
pp. 355
Author(s):  
Matteo Ferro ◽  
Gennaro Musi ◽  
Deliu Victor Matei ◽  
Alessandro Francesco Mistretta ◽  
Stefano Luzzago ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Radical Prostatectomy ◽  
Active Surveillance ◽  
Inflammatory Markers ◽  
Low Risk ◽  
Inclusion Criteria ◽  
Robotic Radical Prostatectomy ◽  
Lymphocyte Ratio ◽  
Risk Prostate Cancer ◽  
Low Risk Prostate Cancer

Background: circulating levels of lymphocytes, platelets and neutrophils have been identified as factors related to unfavorable clinical outcome for many solid tumors. The aim of this cohort study is to evaluate and validate the use of the Prostatic Systemic Inflammatory Markers (PSIM) score in predicting and improving the detection of clinically significant prostate cancer (csPCa) in men undergoing robotic radical prostatectomy for low-risk prostate cancer who met the inclusion criteria for active surveillance. Methods: we reviewed the medical records of 260 patients who fulfilled the inclusion criteria for active surveillance. We performed a head-to-head comparison between the histological findings of specimens after radical prostatectomy (RP) and prostate biopsies. The PSIM score was calculated on the basis of positivity according to cutoffs (neutrophil-to-lymphocyte ratio (NLR) 2.0, platelets-to-lymphocyte ratio (PLR) 118 and monocyte-to-lymphocyte-ratio (MLR) 5.0), with 1 point assigned for each value exceeding the specified threshold and then summed, yielding a final score ranging from 0 to 3. Results: median NLR was 2.07, median PLR was 114.83, median MLR was 3.69. Conclusion: we found a significantly increase in the rate of pathological International Society of Urological Pathology (ISUP) ≥ 2 with the increase of PSIM. At the multivariate logistic regression analysis adjusted for age, prostate specific antigen (PSA), PSA density, prostate volume and PSIM, the latter was found the sole independent prognostic variable influencing probability of adverse pathology.

scholarly journals A novel predictor of clinical progression in patients on active surveillance for prostate cancer

2019 ◽  
Vol 13 (8) ◽  
Author(s):  
Guan Hee Tan ◽  
Antonio Finelli ◽  
Ardalan Ahmad ◽  
Marian Wettstein ◽  
Alexandre Zlotta ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Active Surveillance ◽  
Cox Regression ◽  
Area Under The Curve ◽  
Progression Free Survival ◽  
Roc Curves ◽  
Standard Of Care ◽  
Low Risk ◽  
Clinical Progression

Introduction: Active surveillance (AS) is standard of care in low-risk prostate cancer (PC). This study describes a novel total cancer location (TCLo) density metric and aims to determine its performance in predicting clinical progression (CP) and grade progression (GP).     Methods: This was a retrospective study of patients on AS after confirmatory biopsy (CBx). We excluded patients with Gleason ≥7 at CBx and <2 years follow-up. TCLo was the number of locations with positive cores at diagnosis (DBx) and CBx. TCLo density was TCLo / prostate volume (PV). CP was progression to any active treatment while GP occurred if Gleason ≥7 was identified on repeat biopsy or surgical pathology. Independent predictors of time to CP or GP were estimated with Cox regression. Kaplan-Meier analysis compared progression-free survival curves between TCLo density groups. Test characteristics of TCLo were explored with receiver operating characteristic (ROC) curves.     Results: We included 181 patients who had CBx between 2012-2015, and met inclusion criteria. The mean age of patients was 62.58 years (SD=7.13) and median follow-up was 60.9 months (IQR=23.4). A high TCLo density score (>0.05) was independently associated with time to CP (HR 4.70, 95% CI: 2.62-8.42, p<0.001), and GP (HR 3.85, 95% CI: 1.91-7.73, p<0.001). ROC curves showed TCLo density has greater area under the curve than number of positive cores at CBx in predicting progression.     Conclusion: TCLo density is able to stratify patients on AS for risk of CP and GP. With further validation, it could be added to the decision-making algorithm in AS for low-risk localized PC.

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