Active Surveillance for Prostate Cancers Detected in Three Subsequent Rounds of a Screening Trial: Characteristics, PSA Doubling Times, and Outcome

Roemeling, Stijn; Roobol, Monique J.; Vries, Stijn H. de; Wolters, Tineke; Gosselaar, Claartje; Leenders, Geert J.L.H. van; Schröder, Fritz H.

doi:10.1016/j.eururo.2006.11.053

Cited by 146 publications

(69 citation statements)

References 31 publications

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“…[7][8][9][10] In the only other large, prospective surveillance program with predefined selection and monitoring criteria, and published outcomes, men with clinical stage T2b or less, Gleason score of 7 or less, and PSA 15 ng/ml or less were enrolled. 8 In contrast, all but 1 man in the current study had stage T1c disease, all had a biopsy Gleason score of 6 or less, and 83% had a PSAD of 0.15 ng/ml/cm 3 or less (table 1).…”

Section: Discussionmentioning

confidence: 99%

“…8,[10][11][12] Studies that use PSADT as a criteria to define progression and differentially remove from surveillance those with more rapid increases in PSA (shorter PSADT), leaving those with stable or decreasing PSA values on surveillance, would be likely to show a relationship between PSA kinetics and intervention. We believe that by the time PSA kinetics and clinical signs, eg digital rectal examination changes, suggest progression, the window of curability may have closed.…”

Section: Discussionmentioning

confidence: 99%

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Expectant Management of Prostate Cancer With Curative Intent: An Update of The Johns Hopkins Experience

et al. 2007

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Purpose-We updated our experience with a strategy of expectant treatment for men with stage T1c prostate cancer and evaluated predictors of disease intervention.Materials and Methods-A total of 407 men with a median age of 65.7 years (range 45.8 to 81.5) with stage T1c (99.8%) or T2a (0.2%) prostate cancer suspected of harboring small volume prostate cancer based on needle biopsy findings and prostate specific antigen density have been followed in a prospective, longitudinal surveillance program with a median followup of 2.8 years (range 0.4 to 12.5). A recommendation for treatment was made if disease progression was suggested by unfavorable followup needle biopsy findings (Gleason pattern 4 or 5, greater than 2 biopsy cores with cancer or greater than 50% involvement of any core with cancer). Cox proportional hazards regression was used to evaluate the affect of multiple covariates on the outcome of curative intervention.Results-Of 407 men 239 (59%) men remained on active surveillance at a median followup of 3.4 years (range 0.43 to 12.5), 103 (25%) underwent curative intervention at a median of 2.2 years after diagnosis (range 0.96 to 7.39) and 65 (16%) were either lost to followup (12), withdrew from the program (45), or died of causes other than prostate cancer (8). Older age at diagnosis (p = 0.011) and an earlier date of diagnosis (p = 0.001) were significantly associated with curative intervention.Conclusions-Recognizing that over treatment of prostate cancer is prevalent, especially among elderly patients, a program of careful selection and monitoring of older men who are likely to harbor small volume, low grade disease may be a rational alternative to the active treatment of all.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Expectant Management of Prostate Cancer With Curative Intent: An Update of The Johns Hopkins Experience

et al. 2007

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“…Klotz et al originally used a PSA DT cut-off <2 yr to recommend treatment; however, they increased this value to <3 yr, which applied to approximately 20% of this cohort [9]. Among men on AS from the ERSPC, 44% had a prolonged PSA DT (negative or >10 yr) [41]. Overall, 7.3% of men experienced PSA DTs <2 yr.…”

Section: 5mentioning

confidence: 99%

Active Surveillance for Prostate Cancer: A Systematic Review of the Literature

et al. 2012

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Please visit www.eu-acme.org/ europeanurology to read and answer questions on-line. The EU-ACME credits will then be attributed automatically. AbstractContext: Prostate cancer (PCa) remains an increasingly common malignancy worldwide. The optimal management of clinically localized, early-stage disease remains unknown, and profound quality of life issues surround PCa interventions. Objective: To systematically summarize the current literature on the management of low-risk PCa with active surveillance (AS), with a focus on patient selection, outcomes, and future research needs.

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“…The distinction is particularly important in that neither oncologic, nor quality of life, outcomes from patients assigned to observation in older randomized trials, [8,14], nor those identified in population-based registries as receiving conservative management, can be considered representative of those expected with contemporary active surveillance. Table 1 summarizes the published prospective experience with active surveillance, comprising more than 2900 patients [15][16][17][18][19][20][21][22][23]. These studies differ in terms of their eligibility and triggers for intervention.…”

Section: Active Surveillance Resultsmentioning

confidence: 99%

Active Surveillance for Low-Risk Prostate Cancer

Klotz

2015

Curr Urol Rep

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Active Surveillance for Prostate Cancers Detected in Three Subsequent Rounds of a Screening Trial: Characteristics, PSA Doubling Times, and Outcome

Cited by 146 publications

References 31 publications

Expectant Management of Prostate Cancer With Curative Intent: An Update of The Johns Hopkins Experience

Expectant Management of Prostate Cancer With Curative Intent: An Update of The Johns Hopkins Experience

Active Surveillance for Prostate Cancer: A Systematic Review of the Literature

Active Surveillance for Low-Risk Prostate Cancer

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