Active surveillance in low-risk prostate cancer. Patient acceptance and results

Systematic Review and Meta-analysis of Factors Determining Change to Radical Treatment in Active Surveillance for Localized Prostate Cancer

“…Up to an average of 38% of changes to radical treatments were because of a reclassified Gleason grade (95% CI 27%, 49%, Fig. 4) [14,17,19,[21][22][23]25,27,28,[33][34][35]. In the 17 studies References for the study settings are provided in Table 1.…”

“…detailing reasons, an average of 20% of treatment changes were because of patient choice or anxiety (95% CI 14%, 27%) [12,[14][15][16][17][18][19]22,23,[25][26][27]29,30,32,34,35].…”

“…The frequency of PSA testing, DRE, and rebiopsy during surveillance varied considerably across the studies. An increase in Gleason grade [12,[14][15][16][17][18][19][20][21][22][23][24][25][26][27][28][29][32][33][34][35][36] was the most common trigger for recommendation of a change to radical treatment, followed by other pathological findings [12,14,16-24, 26,27,29,32-36], PSA or PSA kinetics [9,10,12,14,16,17,19,23,26,[28][29][30]32,34,35], and T stage [14,15,17,19,23,26].…”

Obligatory information that a patient diagnosed of prostate cancer and candidate for an active surveillance protocol must know

“…9 However, the increased acceptance of this strategy comes from both the conviction of the professionals involved in PCa and better information on the part of patients, and both Fig. 1 in our case and the data from other center in our country, which show that in the year 2011 only 17% of the possible candidates for AS chose active treatment, 10 are irrefutable data regarding the increase in patients who also choose AS in our environment.…”

Expectant management for men with early stage prostate cancer

“…Recently updated results from the Toronto study (with follow‐up as far out as 20 years) indicated that only 1.5% of the cohort of nearly 1000 patients died from prostate cancer, with a 9.2‐fold greater hazard from other‐cause mortality over that interval . The outcomes from multiple other active surveillance programs have confirmed the feasibility of such strategies for men with low‐risk, clinically localized prostate cancer (Table ) . Recognizing this, researchers in the United Kingdom initiated the Prostate Testing for Cancer and Treatment (ProtecT) study in 2001, which randomized over 1600 prostate cancer patients to either active surveillance or definitive treatment.…”