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

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.

Low-risk prostate cancer: evaluation of quality of life after surgical treatment and during active observation

The study objective is to improve results of treatment of patients with low-risk prostate cancer (PC).Materials and methods. In the study, comparative analysis of data from 84 patients with low-risk PC was performed: 40 patients were included in the active observation group (group 1) and 44 patients underwent radical prostatectomy (group 2). For evaluation of functional responses the following questionnaires were used: Short Form 36 Health Quality Survey (SF-36), International Index of Erectile Function (IIEF-5), International Prostate Symptom Score (IPSS), Expanded Prostate Cancer Index Composite (EPIC-26). For control of oncological results, tests for prostate-specific antigen, digital rectal examination, magnetic resonance imaging of the pelvic organs with intravenous contrast, and confirmation biopsy of the prostate were preformed.Results. Mean score for the SF-36 questionnaire in the group 1 (active observation) at the beginning of the study was 63.2 ± 11.5 for mental health (MH) and 57.1 ± 9.8 for physical health (PH), while in the group 2 MH score was 63.1± 6.8, PH score was 56.2 ± 8.6. However, 18 months later in the group 1 mean MH score increased to 68.2 ± 10.1, mean PH score to 62.4 ± 7.8; in the group 2 PH score increased insignificantly to 64.2 ± 7.4 and PH score decreased to 54.8 ± 5.4 (p <0.05). IIEF-5 score in the group 1 decreased from 18.8 ± 4.2 to 18.3 ± 4.0, in the group 2 from 19.1 ± 4.3 to 16.9 ± 4.8 (p <0.05). Mean IPSS score insignificantly increased in the group 1 from 9.1 ± 2.1 to 9.3 ± 2.7, while in the group 2 it decreased from 9.2 ± 2.3 to 8.4 ± 1.5 (p <0.05). For the EPIC-26 questionnaire, mean score for all criteria initially was 56.1 ± 5.1 in the group 1 and 54 ± 4.4 in the group 2 (after prostatectomy), and currently it increased to 65 ± 4.6 in the group 1 and decreased to 49 ± 5.4 in the group 2.Two (5 %) patients from the group 1 underwent surgical treatment due to PC progression. One (2.5 %) patient chose surgical treatment due to cancer-related anxiety. Biochemical recurrence with an increase in prostate-specific antigen of 0.29 ± 0.09 ng/ml was observed in 3 (6,8 %) patients in the group 2.Conclusion. Strategy of active observation is the preferred method of care for patients with low-risk PC allowing to preserve high quality of life while surgical treatment should be performed only if necessary.

Potential of miRNAs in urinary extracellular vesicles for management of active surveillance in prostate cancer patients

Background Active surveillance is an alternative to radical treatment for patients with low-risk prostate cancer, which could also benefit some patients with intermediate risk. We have investigated the use of miRNA in urinary extracellular vesicles to stratify these patients. Methods NGS was performed to profile the miRNAs from small urinary extracellular vesicles in a cohort of 70 patients with prostate cancer ISUP Grade 1, 2 or 3. The most promising candidates were then analysed by RT-qPCR in a new cohort of 60 patients. Results NGS analysis identified nine miRNAs differentially expressed in at least one of the comparisons. The largest differences were found with miR-1290 (Grade 3 vs. 1), miR-320a-3p (Grade 3 vs. 2) and miR-155-5p (Grade 2 vs. 1). Combinations of 2–3 miRNAs were able to differentiate between two ISUP grades with an AUC 0.79–0.88. RT-qPCR analysis showed a similar trend for miR-186-5p and miR-30e-5p to separate Grade 3 from 2, and miR-320a-3p to separate Grade 2 from 1. Conclusions Using NGS, we have identified several miRNAs that discriminate between prostate cancer patients with ISUP Grades 1, 2 and 3. Moreover, miR-186-5p, miR-320a-3p and miR-30e-5p showed a similar behaviour in an independent cohort using an alternative analytical method. Our results show that miRNAs from urinary vesicles can be potentially useful as liquid biopsies for active surveillance.

Misclassification of Gleason grade and tumor stage in Asian-American patients with low-risk prostate cancer: A SEER-Based Analysis

Background This study aimed to investigate the misclassification rates of Asian-American patients with low-risk prostate cancer who underwent radical prostatectomy (RP). Methods Patients diagnosed with low-risk PCa treated with RP between 2010 and 2015 in the Surveillance, Epidemiology, and End Results (SEER) database were included in this study. Then, basic characteristics and pathological outcomes of enrolled patients were retrospectively extracted. We compared the rates of upgrading and/or upstaging between Asian-American patients and White/Black patients. Moreover, temporal trend analyses were performed to explore the changes in upgrading and upstaging rates in each race over time. Finally, logistic regression models were constructed to explore the role of Asian race in upgrading and upstaging and to screen out potential risk factors for predicting upgrading and upstaging in Asian-American patients. Results In patients with low-risk PCa, Asian-Americans had significantly higher rate of upgrading than Whites (51.25% vs. 45.18%, P<0.001), while no statistical difference was found in the comparison of upstaging rate (10.01 vs. 10.01, P=0.536). Moreover, Asian-Americans were more likely to upgrade to diseases with higher ISUP grade than Whites (P=0.010). The rate of upgrading increased significantly over time in White and Black patients, but not in Asian-American patients. Finally, race seemed to be an independent risk factor for predicting upgrading, while the racial differences seemed to be more pronounced between White and Black patients. Conclusion Asian-American patients had a significantly higher rate of upgrading than White patients. Moreover, Asian-American patients were more likely to upgrade to diseases with higher ISUP grade. Further risk assessment before clinical decision for low-risk PCa patients with the help of significant clinical variables is required.