scholarly journals Outcomes of active surveillance for clinically localized prostate cancer in a middle eastern tertiary care center

2021 ◽  
Vol 93 (4) ◽  
pp. 385-388
Author(s):  
Mohammad Hout ◽  
Ali Merhe ◽  
Nassib Abou Heidar ◽  
Jose M. El-Asmar ◽  
Wassim Wazzan ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Active Surveillance ◽  
Active Treatment ◽  
Tertiary Care ◽  
Specific Antigen ◽  
Digital Rectal Examination ◽  
Low Risk ◽  
Risk Prostate Cancer ◽  
Low Risk Prostate Cancer

Background: The aim of our study was to evaluate the outcome of active surveillance (AS) for prostate cancer for a cohort of patients at our institution. Methods: A total of 43 patients with low risk prostate cancer were enrolled in an active surveillance pilot program at our institution between 2008 and 2018. Follow up protocols included: periodic prostate specific antigen (PSA), digital rectal examination (DRE), multiparametric MRI, and prostate biopsy at one year. Pertinent parameters were collected, and descriptive statistics were reported along with a subset analysis of patients that dropped out of the protocol to receive active treatment for disease progression. Results: Out of 43 eligible patients, 46.5% had a significant rise in follow up PSA. DRE was initially suspicious in 27.9% of patients, and none had any change in DRE on follow up. Initially, prostate MRIs showed PIRADS 3, 4, and 5 in 14%, 37.2%, and 11.6% respectively, while 23.2% had a negative initial MRI. 14% did not have an MRI. Upon follow up, 18.6% of patients had progression on MRI. Initial biopsies revealed that 86% were classified as WHO group 1, while 14% as WHO group 2. With regards to the follow up biopsies, 11.6% were upgraded. 20.9% of our patients had active treatment; 44.4% due to upgraded biopsy results, 22.2% due to PSA progression, 22.2% due to strong patient preference, and 11.1% due to radiologic progression. Conclusions: For selected men with low risk prostate cancer, AS is a reasonable alternative. The decision for active treatment should be tailored upon changes in PSA, DRE, MRI, and biopsy results.

scholarly journals Can we expand the borders in active surveillance for low-risk prostate cancer?

2018 ◽  
Vol 12 (1) ◽  
pp. 54-59
Author(s):  
Ekrem Islamoglu ◽  
Erdem Kisa ◽  
Cem Yucel ◽  
Orcun Celik ◽  
Ozgur Cakmak ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Prostate Specific Antigen ◽  
Active Surveillance ◽  
Specific Antigen ◽  
Low Risk ◽  
Significant Difference ◽  
Risk Prostate Cancer ◽  
Low Risk Prostate Cancer ◽  
The Mean

Purpose: We assessed the outcomes of men with low-risk prostate cancer enrolled in active surveillance. Methods: From January 2008, patients in our clinic who were classified as having low-risk prostate cancer according to the D’Amico classification were included in the protocol. Follow-up consisted of regular prostate-specific antigen tests, digital rectal examinations and biopsies. Outcomes were compared between men who progressed and those who did not, and survival analysis was obtained. Results: The mean follow-up period was 46 months. A total of six patients received curative treatment during follow-up as a result of meeting progression criteria. The mean follow-up time from the beginning of active surveillance until curative therapy was 27.1 months. Four of our 64 patients lost their lives due to diseases other than prostate cancer, none of the patients were lost due to prostate cancer. When patients who showed progression and those who did not were compared in terms of positive core numbers and the core tumour percentage we found no significant difference between the two groups ( P>0.05) Conclusion: Active surveillance seems to be a safe and feasible practice in men with low-risk prostate cancer. Gleason score, clinical stage and initial prostate-specific antigen seem to be the most definite criteria for the selection of patients, while it is thought that the number of positive cores is a matter that can be dealt with more flexibility. Level of evidence: Not applicable for this multicentre audit.

Predicting progression in patients followed with active surveillance for low-risk prostate cancer.

2014 ◽  
Vol 32 (4_suppl) ◽  
pp. 38-38
Author(s):  
Itay Aharon Sternberg ◽  
Changhong Yu ◽  
Gal Elimelech Keren Paz ◽  
Philip H. Kim ◽  
Melanie Bernstein ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Active Surveillance ◽  
Free Probability ◽  
Specific Antigen ◽  
Low Risk ◽  
Inclusion Criteria ◽  
Risk Prostate Cancer ◽  
Risk Of Progression ◽  
Low Risk Prostate Cancer

38 Background: Due to the inability to predict progression and need for treatment, patients with low-risk prostate cancer (LRPC) managed by active surveillance (AS) are subjected to repeated biopsies and their possible complications. We developed a nomogram predicting the risk of progression in patients on AS for LRPC. Methods: A retrospective review of all patients enrolled in an AS program at Memorial Sloan-Kettering Cancer Center (MSKCC) between 1993 and 2012 was conducted. Demographic, clinical, and pathologic data for patients who met the inclusion criteria for AS (cT1 or cT2a, prostate-specific antigen [PSA] less than 10, Gleason 6 or less, no more than three positive biopsy cores and no greater than 50% involvement of any single core) on the diagnostic and the confirmatory biopsies were collected and used to develop a nomogram for predicting progression-free probability. Multivariable logistic regression analysis was used to model the association between each risk variable (age, PSA levels, clinical stage, biopsy features) and disease progression. Progression was defined as failure to meet the inclusion criteria during follow up. Results: A total of 1,095 patients were enrolled in an AS program at MSKCC during the study period, of which 680 met the inclusion criteria for AS on both the diagnostic and the confirmatory biopsies and had available follow-up. At a median follow-up of 3 years 101 patients progressed. A nomogram predicting the progression-free probability was designed based on characteristics at diagnosis, result of a confirmatory biopsy and the number of negative and positive surveillance biopsies to date. A concordance index of 0.596 was calculated. Conclusions: Conditioned upon external validation, this nomogram can be used to counsel patients on their risk of progression and their surveillance protocol can be adjusted appropriately, possibly avoiding unnecessary biopsies and preventing biopsy-related complications.

scholarly journals MP48-17 DO PROGRESSION RATES ON FOLLOW UP BIOPSY OVER TIME DIFFER BETWEEN MEN WITH VERY LOW RISK AND LOW RISK PROSTATE CANCER ON ACTIVE SURVEILLANCE?

2019 ◽  
Vol 201 (Supplement 4) ◽  
Author(s):  
Srinath Kotamarti* ◽  
Andrew Wood ◽  
Alyssa Yee ◽  
Daniel Rabinowitz ◽  
Allison Marziliano ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Active Surveillance ◽  
Low Risk ◽  
Risk Prostate Cancer ◽  
Low Risk Prostate Cancer ◽  
Over Time

Differences among Men on Active Surveillance for Very Low-Risk Prostate Cancer Detected Through Population-Based versus Opportunistic Prostate-Specific Antigen-Screening

2015 ◽  
Vol 94 (3) ◽  
pp. 330-336
Author(s):  
Marco Randazzo ◽  
Josef Beatrice ◽  
Andreas Huber ◽  
Rainer Grobholz ◽  
Lukas Manka ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Active Surveillance ◽  
Cox Regression ◽  
Screening Program ◽  
Specific Antigen ◽  
Population Based ◽  
Low Risk ◽  
Cox Regression Analysis ◽  
Risk Prostate Cancer ◽  
Low Risk Prostate Cancer

Introduction: Very low-risk prostate cancer (PCa) is being increasingly managed by active surveillance (AS). Our aim was to assess the influence of the origin of diagnosis on PCa characteristics and treatment rates among men with very low-risk PCa in our prospective AS cohort. Methods: Overall, 191 men with very low-risk PCa fulfilling Epstein-criteria underwent protocol-based AS. These men originated either from the prospective population-based screening program (P-AS) or were diagnosed by opportunistic screening (O-AS). Results: Overall, n = 86 (45.0%) originated from the P-AS group, whereas n = 105 (55.0%) from the O-AS group. On univariate Cox regression analysis, age (HR 0.96, 95% CI 0.92-1.00; p = 0.05), origin of diagnosis (HR 0.72, 95% CI 0.41-1.28; p = 0.001), number of positive cores (HR 2.15, 95% CI 1.18-3.90; p = 0.01) and maximum core involvement (HR 1.03, 95% CI 0.99-1.05; p = 0.05) were predictors for treatment necessity. On multivariate analysis, age (HR 0.95, 95% CI 0.89-0.99; p = 0.05), number of positive cores (HR 2.07, 95% CI 1.10-3.88; p = 0.02), maximum core involvement (HR 1.03, 95% CI 1.00-1.06; p = 0.04) but not origin of diagnosis were independent predictors for treatment necessity. Four men developed biochemical recurrence (all from O-AS group [p = 0.05]). Conclusion: The origin of PCa diagnosis in men undergoing AS had no influence on disease progression and treatment necessity.

Perspectives of health care professionals on active surveillance for the management of prostate cancer.

2018 ◽  
Vol 36 (6_suppl) ◽  
pp. 81-81
Author(s):  
Fred Saad ◽  
Kittie Pang ◽  
Margaret Fitch ◽  
Veronique Ouellet ◽  
Simone Chevalier ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Health Care ◽  
Active Surveillance ◽  
Health Care Providers ◽  
Low Risk ◽  
Care Providers ◽  
Radiation Oncologists ◽  
Risk Prostate Cancer ◽  
Low Risk Prostate Cancer

81 Background: Active surveillance has gained widespread acceptance as a safe approach for patients with low risk prostate cancer. Despite presenting several advantages for both patients and the health care system, active surveillance is not adopted by all eligible patients. In this study, we evaluated the factors that influence physicians to recommend active surveillance and the barriers that impact adherence to this approach. Methods: We conducted five focus groups with a total of 48 health care providers (HCP) including family physicians, urologists, surgeons, radiation oncologists, fellows, and residents/medical students. These participants were all providing care for men with low risk prostate cancer and had engaged in conversations with men and their families about active surveillance. The experience of these HCP from academic hospitals in four Canadian provinces was captured. A content and theme analysis was performed on the verbatim transcripts to understand HCP decisions in proposing active surveillance and reveal the facilitators that affect the adherence to this approach. Results: Participants agreed that active surveillance is a suitable approach for low risk prostate cancer patients, but expressed concerns on the rapidly evolving and non-standardized guidelines for patient follow-up. They raised the need for additional tools to appropriately identify the patients best suited for active surveillance. Collaborations between urologists, radiation-oncologists, and medical oncologists were favoured, however, the role of general practitioners remained controversial once patients were referred to a specialist. Conclusions: Integration of more reliable tools and/or markers, and more specific guidelines for patient follow-up would help both patients and physicians in the decision-making for active surveillance.

Sign in / Sign up

Export Citation Format

Share Document