Active surveillance for low-risk prostate cancer: Need for intervention and survival at 10 years

Preston, Mark A.; Feldman, Adam S.; Coen, John J.; McDougal, W. Scott; Smith, Matthew R.; Paly, Jonathan J.; Carrasquillo, Robert; Wu, Chin‐Lee; Dahl, Douglas M.; Barrisford, Glen W.; Blute, Michael L.; Zietman, Anthony

doi:10.1016/j.urolonc.2015.04.015

Cited by 28 publications

(17 citation statements)

References 32 publications

(44 reference statements)

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“…Our AS failure rate is 38.5% is slightly higher compared to other cohorts as reported by Klotz et al [11], PRIAS [9], Tosoian et al [10], Preston et al [12], Dall’Era et al [13], (22.6, 28, 30.6, 34.7, 38%). These variations in failure rates may result from different criteria or the population utilized for the study.…”

Section: Discussioncontrasting

confidence: 41%

Impact of bilateral biopsy-detected prostate cancer on an active surveillance population

et al. 2019

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Background To assess factors that can predict active surveillance (AS) failure on serial transrectal ultrasound guided biopsies in patients with low-risk prostate cancer. Methods We evaluated the records of 144 consecutive patients enrolled in AS between 2007 and 2014 at a single academic institution. Low risk inclusion criteria included PSA < 10 ng/ml, cT1c or cT2a, Grade Group (GG) 1, < 3 positive cores, and < 50% tumor in a single core with the majority having a PSA density of < 0.15. AS reclassification was defined as progression to GG ≥2, 3 or more cores, or core tumor volume ≥ 50%. Univariate and multivariate Cox proportional hazards regression analysis was used to determine predictors of reclassification and a match-pair analysis performed on a control group of patients choosing surgery. Results Inclusion criteria were met by 130 men with a median follow-up of 52 months. The reclassification or AS failure rate was 38.5%, with the majority 41/50 (82%) finding GG ≥ 2 cancer. Most patients had unilateral disease on diagnostic biopsy (94.6%), but 40.7% had bilateral cancer detected during follow-up. Men with bilateral detected tumor were more likely to ultimately fail AS than patients with unilateral tumors (HR 4.089; P < 0.0001) and failed earlier with a reclassification-free survival of 32 vs 119 months respectively. In a matched-pair analysis using a population of 211 concurrent patients that chose radical prostatectomy rather than AS, 76% of patients with unilateral cancer on biopsy had bilateral cancer on final pathology. Conclusions The finding of bilateral prostate cancer on biopsy is associated with earlier AS reclassification. Finding bilateral disease may not represent disease progression, but rather enhanced detection of more extensive disease highlighting the importance of confirmatory biopsy.

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Section: Discussioncontrasting

confidence: 41%

Impact of bilateral biopsy-detected prostate cancer on an active surveillance population

et al. 2019

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“…Hence, active surveillance has emerged as an alternative treatment option for men with early-stage disease, without compromising overall and cancer-specific survival. In contemporary cohorts of patients managed with such strategy, freedom from treatment was reported to be around 80% at 5 years and 60% at 10 years (5). Common reasons for change in patient management are upgrading of the histological grade (Gleason score) and volume progression.…”

Section: Introductionmentioning

confidence: 99%

Vitamin D3 Prevents Calcium-Induced Progression of Early-Stage Prostate Tumors by Counteracting TRPC6 and Calcium Sensing Receptor Upregulation

et al. 2017

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Active surveillance has emerged as an alternative to immediate treatment for men with low-risk prostate cancer. Accordingly, identification of environmental factors that facilitate progression to more aggressive stages is critical for disease prevention. Although calcium-enriched diets have been speculated to increase prostate cancer risk, their impact on early-stage tumors remains unexplored. In this study, we addressed this issue with a large interventional animal study. Mouse models of fully penetrant and slowly evolving prostate tumorigenesis showed that a high calcium diet dramatically accelerated the progression of prostate intraepithelial neoplasia, by promoting cell proliferation, micro-invasion, tissue inflammation, and expression of acknowledged prostate cancer markers. Strikingly, dietary vitamin D prevented these calcium-triggered tumorigenic effects. Expression profiling and in vitro mechanistic studies showed that stimulation of PC-3 cells with extracellular Ca resulted in an increase in cell proliferation rate, store-operated calcium entry (SOCE) amplitude, cationic channel TRPC6, and calcium sensing receptor (CaSR) expression. Notably, administration of the active vitamin D metabolite calcitriol reversed all these effects. Silencing CaSR or TRPC6 expression in calcium-stimulated PC3 cells decreased cell proliferation and SOCE. Overall, our results demonstrate the protective effects of vitamin D supplementation in blocking the progression of early-stage prostate lesions induced by a calcium-rich diet. Cancer Res; 77(2); 355-65. ©2016 AACR.

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“…There is a growing body of literature verifying that AS is a reasonable and safe management strategy for selected PCa patients. In a recent report on a series of 469 men being managed by AS between 1997 and 2009, the 10-year cancer specific survival rate was 100% [50]. However, about a quarter of this cohort dropped out of the AS-protocol, most commonly due to pathologic progression on re-biopsy, PSA-progression, and patient preference, and the estimated probability of undergoing treatment within 10 years after the start of AS was reported to be 38% [50].…”

Section: Dw-mri As a Support For Management Decisionsmentioning

confidence: 99%

“…In a recent report on a series of 469 men being managed by AS between 1997 and 2009, the 10-year cancer specific survival rate was 100% [50]. However, about a quarter of this cohort dropped out of the AS-protocol, most commonly due to pathologic progression on re-biopsy, PSA-progression, and patient preference, and the estimated probability of undergoing treatment within 10 years after the start of AS was reported to be 38% [50]. Given this considerable drop-out rate, there is the need for more reliable risk-assessment tools that can substantiate the decision of AS eligibility.…”

Section: Dw-mri As a Support For Management Decisionsmentioning

confidence: 99%

The expanding landscape of diffusion-weighted MRI in prostate cancer

et al. 2016

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The added value of diffusion-weighted magnetic resonance imaging (DW-MRI) for the detection, localization, and staging of primary prostate cancer has been extensively reported in original studies and meta-analyses. More recently, DW-MRI and related techniques have been used to non-invasively assess prostate cancer aggressiveness and estimate its biological behavior. The present article aims to summarize the potential applications of DW-MRI for non-invasive optimization of pretherapeutic risk assessment, patient management decisions, and evaluation of treatment response.

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Active surveillance for low-risk prostate cancer: Need for intervention and survival at 10 years

Cited by 28 publications

References 32 publications

Impact of bilateral biopsy-detected prostate cancer on an active surveillance population

Impact of bilateral biopsy-detected prostate cancer on an active surveillance population

Vitamin D3 Prevents Calcium-Induced Progression of Early-Stage Prostate Tumors by Counteracting TRPC6 and Calcium Sensing Receptor Upregulation

The expanding landscape of diffusion-weighted MRI in prostate cancer

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