Active Surveillance Compared With Initial Treatment for Men With Low-Risk Prostate Cancer

The Variability of Patient Preferences

“…The spread in values found here echoed a similar discovery made in a study of patients with angina, in which researchers found that patients with comparable symptoms nonetheless varied considerably in their tolerance for these symptoms [21]. Similarly, Hayes et al [14] found that the best choice between active surveillance versus initial treatment for men with localized prostate cancer was highly dependent on patient preferences. Subjects' stated threshold exceeded the calculated threshold on average by 27%.…”

A 17-gene Assay to Predict Prostate Cancer Aggressiveness in the Context of Gleason Grade Heterogeneity, Tumor Multifocality, and Biopsy Undersampling

“…Serial prostate biopsies are uncomfortable and are associated with risks of bleeding, serious infection [46] and other adverse consequences [47]. Patients on surveillance can experience varying degrees of anxiety regarding the potential of their cancers to progress [48]. Additional studies are needed to determine whether GPS might also be used to identify men who may be candidates for less intense surveillance and perhaps some whose tumor characteristics are so indolent that they may be spared a diagnosis of ''cancer'' or converted to a program of watchful waiting, a less intensive alternative to AS [49,50].…”

PSA-based prostate cancer screening: the role of active surveillance and informed and shared decision making

“…Utilities derived from Ref. 36 were used by Hayes et al 16 in a modeling study. They concluded that under a wide range of assumptions AS is a reasonable approach for a 65-yearold man with low-risk PC.…”

“…They concluded that under a wide range of assumptions AS is a reasonable approach for a 65-yearold man with low-risk PC. Hayes et al 16 performed a decision analysis to assess the quality-adjusted life expectancy of AS compared with initial definitive treatment with radical prostatectomy, intensitymodulated radiation therapy or brachytherapy. The authors reported that AS was the most effective strategy, with intensity-modulated radiation therapy for progression.…”

“…Due to PSA-based screening for PC, increasing numbers of patients with low-risk tumors (with low risk for both metastasis and mortality) are being detected. 1 These potentially clinically insignificant PCs (PSA,10 ng ml 21 , stage fT2a disease and Gleason f6) 16,17 would not have been diagnosed without screening and may not lead to symptoms or death during the patient's lifetime. Within the screening arm of the ERSPC (section Rotterdam, the Netherlands), 27-56% of all cancers detected in men aged 55-75 years can be classified as potentially overdiagnosed.…”