Long-term follow-up of conservatively managed incidental carcinoma of the prostate A multivariate analysis of prognostic factors

Robinson, David; Aus, Gunnar; Bak, Julia; Górecki, Tomasz; Herder, Anders; Rosell, Johan; Varenhorst, Eberhard

doi:10.1080/00365590600991268

Cited by 35 publications

(33 citation statements)

References 19 publications

(14 reference statements)

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“…They reported that higher Gleason grade, higher nuclear grade, and larger tumour volume were independent predictors of death in prostate cancer. In another report, Robinson and colleagues 6 found that 33 (17%) of 197 cases of incidental prostate cancer who were managed conservatively died from prostate cancer during the mean 7.8-year follow-up. Again, their data indicated that high Gleason score, T1b, and high immunoreactivity of Ki-67 were independent predictors of diseasespecific mortality.…”

Section: Resultsmentioning

confidence: 99%

“…4 Although most of the incidental prostate cancers are considered clinically insignificant, recent studies have suggested that in some of them, the clinical course becomes more unfavourable. 5,6 The main preoperative diagnostic tools to confirm prostate cancer include serum concentration of prostate-specific antigen (PSA), digital rectal examination (DRE), and imaging modalities. The positive predictive values, however, of DRE 7 and transrectal ultrasonography (TRUS) 8 are limited.…”

Section: Introductionmentioning

confidence: 99%

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Preoperative parameters to predict incidental (T1a and T1b) prostate cancer

Sakamoto¹,

Matsumoto²,

Hayakawa³

et al. 2014

CUAJ

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Cite as: Can Urol Assoc J 2014;8(11-12):e815-20. http://dx.doi.org/10.5489/cuaj.1890 Published online November 24, 2014. AbstractIntroduction: Prostate cancer has been found incidentally in transurethral resection of the prostate (TURP) specimens without prior diagnosis in 5% to 13% of the patients. We evaluated whether incidental prostate cancer (stages T1a and T1b) could be predicted preoperatively. Methods: TURP was performed in 307 patients between 2006 and 2011. Patient age, prostate-specific antigen (PSA) level, total prostate volume, transitional zone volume, PSA density, history of needle biopsy, and pathological diagnosis on TURP specimen were assessed. We analyzed the association between these parameters and prostate cancer detection. Results: Incidental prostate cancer was found in 31 patients

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Section: Resultsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Preoperative parameters to predict incidental (T1a and T1b) prostate cancer

Sakamoto¹,

Matsumoto²,

Hayakawa³

et al. 2014

CUAJ

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“…For the T1a category without invasive therapy, Chodak et al [25] and Jonsson et al [4] reported tumour-specific survival of 94% after 10 years, and 90% after 15 years. Robinson et al [5] studied 197 patients with T1a/b disease who were on WW.…”

Section: Discussionmentioning

confidence: 99%

“…The incidence of IPCa has been reported to be 5.2-6.4% [2,3], but no unequivocal statement regarding the appropriate treatment has thus far been made, because only studies with small numbers of cases are currently available. For patients with IPCa and a low Gleason score (≤6) there are good reasons for proceeding with non-invasive protocols, as several studies have shown that cancer-specific survival times are approximately equal to normal life expectancy [4,5]. Noninvasive approaches include active surveillance (AS) and watchful waiting (WW).…”

Section: Introductionmentioning

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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“…The PSA levels were measured at three laboratories in the healthcare region and the laboratories were operating under standardised conditions (with a method calibrated against the Stanford 90:10 PSA standard [187]. A pathology re-review of Gleason scoring in this register was also performed and high immune reactivity of Ki-67 was suggested as independent adverse predictor of disease-specific mortality in patients after initial watchful waiting [188]. A further strength of the study is that the SERPCR has a high validity regarding cause of death based on comparison of registration in the SERPCR and that in the national Cause of Death Register.…”

Section: Paper Imentioning

confidence: 99%

Disease-Specific Survival in Prostate Cancer Patients : Results from the Scandinavian Prostate Cancer Group (SPCG) Trial No. 5 and Regional Cancer Register Data

Klaff¹

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Introduction Prostate cancer (PCa) is the most common cancer among men in Sweden. The clinical course varies considerably, which makes it difficult to predict the prognosis in the individual case. In order to explore the early as well as the late course of the disease, large study groups and population-based cohorts are necessary. Aims To explore factors that influence the long-term outcome of men with low-risk tumours in a population-based register, to predict the long-term course, and to assess the mortality rate for men with prostate cancer (Paper I) To analyse long-term outcome and to investigate factors associated with long-term survival in patients with metastases to the skeleton (Paper II) To analyse early androgen deprivation treatment (ADT) failure and to define clinical predictors associated with short survival due to early ADT failure in prostate cancer patients with bone metastases (Paper III) To analyse the prognostic significance of the extent of bone metastases in relation to other pretreatment variables in prostate cancer patients, and to explore the impact of bone metastases on quality-of-life (Paper IV) Material and methods The study groups were assembled from The South East Region Prostate Cancer Register (SERPCR), and The Scandinavian Prostate Cancer Group (SPCG) Trial No. 5. In the first study, prognostic factors and long-term disease-specific mortality rates of low-risk prostate cancer patients from the early PSA era were analysed. In the second study, patient-related factors, quality-of-life (QoL) and long-term survival in 915 PCa patients with bone metastases (M1b) under ADT, were analysed. In Study III factors predicting primary failure to respond to ADT were identified. Study IV explored the impact of the extent of bone metastases on survival and QoL for these men. Result and conclusions The long-term disease-specific mortality of low-risk localised PCa is low, but the annual mortality rate gradually increases. This indicates that some tumours slowly develop into lethal cancer, particularly in men 70 years or older and with a PSA level ≥ 4 μg/L. From the SPCG Trial No. 5, a subgroup of patients with M1b disease and favourable set of predictive factors survived more than 10 years under ADT with an acceptable QoL. Independent predictors of long-term survival were identified as performance status (PS) < 2, limited extent of bone metastases, and a PSA level < 231 μg/L at the time of enrolment in the trial. However, four independent clinical predictors of early ADT failure could be defined. Men exhibiting these features should be considered for an alternative treatment. Patient grouping based on three categories of extent of bone metastases related to PS, haemoglobin, and QoL at presentation, as independent predictors of mortality, may provide improved accuracy of prognosis

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Long-term follow-up of conservatively managed incidental carcinoma of the prostate A multivariate analysis of prognostic factors

Abstract: Elderly men with category T1a and/or Gleason score 4-5 prostate cancer have a favourable prognosis with conservative management. Immunohistochemical staining with Ki-67 may be of help in situations where further prognostic information is required.

Cited by 35 publications

References 19 publications

Preoperative parameters to predict incidental (T1a and T1b) prostate cancer

Preoperative parameters to predict incidental (T1a and T1b) prostate cancer

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

Disease-Specific Survival in Prostate Cancer Patients : Results from the Scandinavian Prostate Cancer Group (SPCG) Trial No. 5 and Regional Cancer Register Data

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