Active Surveillance of Prostate Cancer: Use, Outcomes, Imaging, and Diagnostic Tools

Abstract

Active surveillance (AS) has emerged as a standard management option for men with very low-risk and low-risk prostate cancer, and contemporary data indicate that use of AS is increasing in the United States and abroad. In the favorable-risk population, reports from multiple prospective cohorts indicate a less than 1% likelihood of metastatic disease and prostate cancer-specific mortality over intermediate-term follow-up (median 5 to 6 years). Higher-risk men participating in AS appear to be at increased risk of adverse outcomes, but these populations have not been adequately studied to this point. Although monitoring on AS largely relies on serial prostate biopsy, a procedure associated with significant morbidity, there is a need for improved diagnostic tools for patient selection and monitoring. Revisions from the 2014 International Society of Urologic Pathology consensus conference have yielded a more intuitive reporting system and detailed reporting of low-intermediate grade tumors, which should facilitate the practice of AS. Meanwhile, emerging modalities such as multiparametric magnetic resonance imaging and tissue-based molecular testing have shown prognostic value in some populations. At this time, however, these instruments have not been sufficiently studied to consider their routine, standardized use in the AS setting. Future studies should seek to identify those platforms most informative in the AS population and propose a strategy by which promising diagnostic tools can be safely and efficiently incorporated into clinical practice.

Active surveillance voor prostaatkanker: vergelijking van uitkomsten tussen patiënten die wel of niet aan de PRIAS-criteria voldoen

“…In dit cohort hadden 57 patiënten bij baseline een PSAD ≥ 0,2 en > 2 positieve biopten, en 7 ontwikkelden metastasen (12%). Een actueel onderwerp op het gebied van AS is de mate waarin de selectiecriteria zouden kunnen worden uitgebreid [9][10][11]. Hoewel er beperkte informatie beschikbaar is over de veiligheid van AS voor patiënten met een hoger-risico-PCa, geven de resultaten van dit onderzoek aan dat de 'indicatie' (op basis van gehanteerde selectiecriteria) in de dagelijkse praktijk al wordt verruimd.…”

Image-based patch selection for deep learning to improve automated Gleason grading in histopathological slides

“…In the United States, prostate cancer is the third deadliest and most common cancer in men [1]. Prostate biopsy is one of the key components in monitoring patients with low to intermediate risk for clinically localized prostate cancer [2,3]. Biopsies are performed repeatedly, each producing several tissue slides.…”

Prognostic utility of biopsy‐derived cell cycle progression score in patients with National Comprehensive Cancer Network low‐risk prostate cancer undergoing radical prostatectomy: implications for treatment guidance

“…This is especially true for the subset of GS6 tumours that meet the clinical qualifications for National Comprehensive Cancer Network (NCCN) low‐risk disease or Cancer of the Prostate Risk Assessment (CAPRA) low‐risk disease, as the available clinical variables add little to no additional prognostic discrimination within this narrowly defined patient subset. Indeed, some men, even those with high‐volume GS6 cancers, may be reasonable candidates for AS based on their underlying tumour biology, but ultimately undergo definitive therapy . Conversely, some men with clinical and pathological findings consistent with low‐risk cancer in fact harbour a more aggressive phenotype .…”

“…Tissue‐based genomic tests, such as the cell cycle progression (CCP) score, can help decrease prognostic uncertainty and improve risk stratification of GS6 PCa . Previous studies have shown that CCP scores measured in prostate biopsy and radical prostatectomy (RP) specimens were predictive of several clinical outcomes ; however, it is currently unclear whether the CCP score improves clinical risk stratification within NCCN low‐risk PCa or GS6 tumours more generally.…”