Active Surveillance for Low-Risk Prostate Cancer

Klotz, Laurence

doi:10.1007/s11934-015-0492-z

Cited by 50 publications

(37 citation statements)

References 77 publications

(32 reference statements)

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“…Low risk and many cases of low-intermediate risk prostate cancer are indolent, have little or no metastatic potential, and do not pose a threat to the patient in his lifetime [1]. Active Surveillance is increasingly accepted as a treatment option for favorable-risk prostate cancer as it may reduce the risk of overtreatment of clinically insignificant prostate cancer while retaining the option for definitive therapy for patients who are reclassified over time as higher risk [2].…”

Section: Introductionmentioning

confidence: 99%

“…The principle modality of active surveillance follow-up is a combination of serial prostatespecific antigen (PSA) measurements and digital rectal exams (DRE). An unmet need among physicians and patients using the active surveillance approach has been a means of avoiding the 25% to 30% risk of misclassification inherent in a systematic biopsy-based diagnostic strategy [1].…”

Section: Introductionmentioning

confidence: 99%

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Improved risk assessment using a novel cancer-specific biomarker assay derived from autoantibody signatures for men with non-aggressive prostate cancer who are not receiving treatment

Wang¹,

Hafron²,

Yu³

et al. 2017

Biomed Res Rev

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Diagnosis of Gleason 6 prostate cancer can leave uncertainty about the presence of undetected aggressive disease. To reduce overdiagnosis and overtreatment of indolent disease, a noninvasive and easy-to-administer test is needed to better stratify risk in patients with clinically insignificant disease. For men on active surveillance, such an assay must also be able to help accurately inform whether a prostate biopsy is warranted, and it must be able to more closely monitor patients with non-aggressive disease.Objective: To evaluate the performance of a novel, serum-based multiplexed autoantibody assay plus age versus PSA for discriminating high-grade prostate cancer (Gleason Score 7 or greater) from Gleason 6 among patients who have positive biopsies. Methods:Using retrospective serum samples, the autoantibody assay results were compared with biopsy outcomes in 377 patients (an autoantibody-binding peptide discovery study of 146 samples, a training set of 231 total samples (90 + 141) and a validation cohort comprised of approximately 1/3-2/3 1000X protocol involving a total of 231 samples (90 + 141)) with prostate cancer (Gleason 6 or greater). Samples were sourced from two academic sites and one community clinical facility in the United States. Eligible participants included men aged 40 years or older undergoing a prostate biopsy due to suspicious digital rectal examination finding and/ or elevated PSA level.Results: Among the 377 men (median age 63.2 years; median PSA 7.4 ng/mL), the autoantibody assay plus Age showed better discrimination (Area Under the Curve (AUC) 0.83, 95% CI 0.76-0.90) than PSA alone (AUC 0.60, 95% CI 0.52-0.68) (P =0.001) for separating Gleason Score 7 or greater from Gleason Score 6 in prostate cancer positive patients. For detected Gleason Score 7 or higher test with 95% sensitivity, 24.4% of total biopsies could have been avoided, missing only 3.9% or six (6) patients with Gleason Score 7 disease. Of these six (6) patients whose cancers were missed, a sub-analysis revealed five were Gleason 7 (3+4) and only one was Gleason 7 (4+3). Conclusion:This study evaluated a novel, cancer-specific biomarker assay based on autoantibody signatures that could be used as a noninvasive risk assessment aid for men with non-aggressive disease who are not receiving treatment. When results of this assay are combined with traditional clinical risk factors, risk stratification for high-grade prostate cancer and biopsy decision making are improved compared to current methods in clinical practice. We hypothesize patients with Gleason Score 6 will exhibit the greatest benefits from employing the assay as they may likely avoid both unnecessary prostate biopsy and subsequent overtreatment. We further hypothesize the assay will thus significantly reduce costs to the healthcare system while further improving patient's quality of care. Providers and their patients diagnosed with indolent prostate cancer may consider using this novel assay prior to proceeding with prostate biopsy or other treatments.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Improved risk assessment using a novel cancer-specific biomarker assay derived from autoantibody signatures for men with non-aggressive prostate cancer who are not receiving treatment

Wang¹,

Hafron²,

Yu³

et al. 2017

Biomed Res Rev

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“…Active surveillance (AS) is an accepted option for the initial management of carefully selected men with localized, well-differentiated prostate cancer who are thought to have a low risk of progression [1][2][3][4] . AS is broadly described as a management option for patients with low-risk prostate cancer, which involves the postponement or avoidance of invasive treatment, with a switch to curative treatment if evidence is obtained that the patient has an increased risk of disease progression or if the patient expresses preference for it.…”

mentioning

confidence: 99%

“…The terms AS and WW are frequently used interchangeably, but they refer to very different observational approaches. AS involves the avoidance or postponement of immediate therapy combined with careful surveillance; definitive treatment is then offered if there is evidence that the patient is at increased risk of disease progression 4 . AS differs from WW, which is based upon the premise that men will not benefit from definitive treatment of clinically localized prostate cancer owing to limited life expectancy, comorbidity, and the prolonged natural history of the prostate cancer 4 .…”

mentioning

confidence: 99%

“…AS involves the avoidance or postponement of immediate therapy combined with careful surveillance; definitive treatment is then offered if there is evidence that the patient is at increased risk of disease progression 4 . AS differs from WW, which is based upon the premise that men will not benefit from definitive treatment of clinically localized prostate cancer owing to limited life expectancy, comorbidity, and the prolonged natural history of the prostate cancer 4 . Patients managed using a WW protocol undergo observation consisting of a lesser degree of monitoring than those on AS might receive, and in which palliative treatment is generally instituted if metastases or local symptoms develop.…”

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confidence: 99%

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Semantics in active surveillance for men with localized prostate cancer — results of a modified Delphi consensus procedure

et al. 2017

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| Active surveillance (AS) is broadly described as a management option for men with low-risk prostate cancer, but semantic heterogeneity exists in both the literature and in guidelines. To address this issue, a panel of leading prostate cancer specialists in the field of AS participated in a consensus-forming project using a modified Delphi method to reach international consensus on definitions of terms related to this management option. An iterative three-round sequence of online questionnaires designed to address 61 individual items was completed by each panel member. Consensus was considered to be reached if ≥70% of the experts agreed on a definition. To facilitate a common understanding among all experts involved and resolve potential ambiguities, a face-to-face consensus meeting was held between Delphi survey rounds two and three. Convenience sampling was used to construct the panel of experts. In total, 12 experts from Australia, France, Finland, Italy, the Netherlands, Japan, the UK, Canada and the USA participated. By the end of the Delphi process, formal consensus was achieved for 100% (n = 61) of the terms and a glossary was then developed. Agreement between international experts has been reached on relevant terms and subsequent definitions regarding AS for patients with localized prostate cancer. This standard terminology could support multidisciplinary communication, reduce the extent of variations in clinical practice and optimize clinical decision making.312 | MAY 2017 | VOLUME 14 www.nature.com/nrurol CONSENSUS STATEMENT © 2 0 1 7 M a c m i l l a n P u b l i s h e r s L i m i t e d , p a r t o f S p r i n g e r N a t u r e . A l l r i g h t s r e s e r v e d .degree of monitoring than those on AS might receive, and in which palliative treatment is generally instituted if metastases or local symptoms develop. Interpreting and comparing research results is difficult owing to the nonstandardized use of the terms AS and WW and their intended and often mixed treatment objectives (curative or palliative) 5 . This semantic heterogeneity is also reflected in AS guidelines 6 . In these guidelines, AS is primarily recommended for patients with low-risk tumours; however, these guidelines contain various definitions of low-risk prostate cancer, as specified by different combinations of clinical criteria including clinical and pathological characteristics (such as tumour stage, serum PSA levels, biopsy Gleason score, tumour volume and serum PSA density). Furthermore, definitions of disease reclassification and progression differ among published guidelines and multiple criteria for initiation of curative treatment are proposed 6 .Problems resulting from the use of ambiguous language include hindered clinical decision making, particularly in multidisciplinary collaborations, and limited opportunities for research 7 . Moreover, such ambiguity has raised a barrier that hampers exchange of knowledge within and between fundamental domains of research and research groups 8 . An urgent need exists for uniform...

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A Novel Urine Exosome Gene Expression Assay to Predict High-grade Prostate Cancer at Initial Biopsy

et al. 2016

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This urine exosome gene expression assay is a noninvasive, urinary 3-gene expression assay that discriminates high-grade (≥GS7) from low-grade (GS6) cancer and benign disease. In this study, the urine exosome gene expression assay was associated with improved identification of patients with higher-grade prostate cancer among men with elevated PSA levels and could reduce the total number of unnecessary biopsies.

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Active Surveillance for Low-Risk Prostate Cancer

Cited by 50 publications

References 77 publications

Improved risk assessment using a novel cancer-specific biomarker assay derived from autoantibody signatures for men with non-aggressive prostate cancer who are not receiving treatment

Improved risk assessment using a novel cancer-specific biomarker assay derived from autoantibody signatures for men with non-aggressive prostate cancer who are not receiving treatment

Semantics in active surveillance for men with localized prostate cancer — results of a modified Delphi consensus procedure

A Novel Urine Exosome Gene Expression Assay to Predict High-grade Prostate Cancer at Initial Biopsy

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