Active Surveillance Program for Prostate Cancer: An Update of the Johns Hopkins Experience

Tosoian, Jeffrey J.; Trock, Bruce J.; Landis, Patricia; Feng, Zhaoyong; Epstein, Jonathan I.; Partin, Alan W.; Walsh, Patrick C.; Carter, H. Ballentine

doi:10.1200/jco.2010.32.8112

Cited by 540 publications

(509 citation statements)

References 29 publications

(13 reference statements)

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“…Most clinical studies mention T1c and T2a tumours almost exclusively. T1a/b cancer is either not included in the reports, not specified separately or represented only sparingly [20][21][22], e.g. 4.8% in the report by Klotz et al [8].…”

Section: Discussionmentioning

confidence: 99%

Active surveillance in localized prostate cancer: comparison of incidental tumours (T1a/b) and tumours diagnosed by core needle biopsy (T1c/T2a): results from the HAROW study

Herden

Wille

Weißbach³

2015

BJU International

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ObjectiveTo conduct a comparative prospective analysis of patients with incidental T1a/T1b prostate cancer (IPCa) and those with prostate cancer (PCa) diagnosed by core needle biopsy, treated by active surveillance (AS), with regard to inclusion criteria, progression and switch to deferred treatment. Patients and MethodsThe HAROW study is an observational outcomes research study on the management of localized PCa. Treating urologists reported clinical variables and information on therapy and clinical course of disease at 6-month intervals. With respect to therapy, only recommendations were made; the final decision on the therapeutic method rested with the treating physician. ResultsOut of 2 957 patients included in the HAROW study, 447 chose AS. The median follow-up was 28.3 months. T1a, T1b, T1c and T2a disease were diagnosed in 81, 18, 292 and 56 patients, respectively. Patients in the IPCa group had lower prostate-specific antigen (PSA) levels (4.2 vs 6.1 ng/mL) and more comorbidities than those diagnosed by core needle biospy. The IPCa group also had fewer re-biopsies (25.3 vs 43.2%) and fewer changes to invasive treatment (12.1 vs 25.9%). No significant differences were found with respect to the criteria for discontinuation, subsequent therapies and histological findings after radical prostatectomy. ConclusionUrologists are highly inclined to use AS as a therapeutic option in IPCa. More patients with IPCa than those diagnosed after core needle biopsy continued on AS, which was also associated with the indication for a re-biopsy being less stringently observed.

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Section: Discussionmentioning

confidence: 99%

Active surveillance in localized prostate cancer: comparison of incidental tumours (T1a/b) and tumours diagnosed by core needle biopsy (T1c/T2a): results from the HAROW study

Herden

Wille

Weißbach³

2015

BJU International

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“…Criteria for AS set forth from published series are shown in Table 1 [7][8][9][10][11][12][13][14][15]. First described in 1994, and then updated in 2004, the Epstein criteria integrate biopsy criteria with clinical data to identify potentially low-risk tumors and are among the most commonly used methods to identify lowrisk disease [16,17].…”

Section: Criteria For Active Surveillancementioning

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 cost of the Roth, Ramsey, Carlson 8-protein prostate cancer prognostic assay was provided by Metamark Genetics ($3,800). For patients on active surveillance, we calculated a bundled monthly cost based on the protocol recommended by Tosoian et al [18]. Specifically, the active surveillance protocol involved biannual office visits and PSA tests and one annual biopsy.…”

Section: Cost Inputsmentioning

confidence: 99%

Cost-Effectiveness of a Biopsy-Based 8-Protein Prostate Cancer Prognostic Assay to Optimize Treatment Decision Making in Gleason 3 + 3 and 3 + 4 Early Stage Prostate Cancer

2015

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Background. Many patients with Gleason 3 1 3 and 3 1 4 early stage prostate cancer receive invasive treatment but likely derive little or no benefit. A novel 8-protein prognostic assay generates a risk score at time of biopsy that is predictive of prostate cancer aggressiveness and can inform treatment decisions. The objective of this study was to evaluate the costeffectiveness of using the assay to inform treatment decisions compared with usual care. Patients and Methods. We developed a simulation model to estimate quality-adjusted life-year (QALY) and cost outcomes for the 8-protein assay and usual care strategies. Risk classification outcomes, treatment distributions, costs, health state utilities, and mortality rates were derived from the assay's validation study and the peer-reviewed literature. Outcomes included incremental QALYs, costs, and costeffectiveness ratios. We conducted one-way and probabilistic

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Active Surveillance Program for Prostate Cancer: An Update of the Johns Hopkins Experience

Abstract: For carefully selected men, active surveillance with curative intent appears to be a safe alternative to immediate intervention. Limiting surveillance to very-low-risk patients may reduce the frequency of adverse outcomes.

Cited by 540 publications

References 29 publications

Active surveillance in localized prostate cancer: comparison of incidental tumours (T1a/b) and tumours diagnosed by core needle biopsy (T1c/T2a): results from the HAROW study

Active surveillance in localized prostate cancer: comparison of incidental tumours (T1a/b) and tumours diagnosed by core needle biopsy (T1c/T2a): results from the HAROW study

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

Cost-Effectiveness of a Biopsy-Based 8-Protein Prostate Cancer Prognostic Assay to Optimize Treatment Decision Making in Gleason 3 + 3 and 3 + 4 Early Stage Prostate Cancer

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