Management and Survival of Screen-Detected Prostate Cancer Patients who Might Have Been Suitable for Active Surveillance

Roemeling, Stijn; Roobol, Monique J.; Postma, Renske; Gosselaar, Claartje; Kwast, Theodorus H. van der; Bangma, Chris H.; Schröder, Fritz H.

doi:10.1016/j.eururo.2006.04.019

Cited by 70 publications

(54 citation statements)

References 27 publications

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“…The origin of the articles and clinical characteristics of the subgroups of patients with microfocal carcinoma are given in Table 1. Four studies reported on men who were diagnosed in the context of the European Randomized Trial for Screening of Prostate Cancer either in the Netherlands 11,21,47 or in Sweden. 44 Details of patient selection are provided in Table 2.…”

Section: Resultsmentioning

confidence: 99%

“…Of the 15 articles that provided complete information in this area, 10 articles [16][17][18][21][22][23][24]40,45,48 reported tumor present in all specimens, and 5 articles 11,25,26,43,47 reported no tumor (pathologic T0 tumor classification) in a small percentage of patients. Overall, there was no tumor reported in 0.8% of patients (7 of 879 patients).…”

Section: Findings In the Radical Prostatectomy Specimenmentioning

confidence: 99%

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The clinical management of patients with a small volume of prostatic cancer on biopsy: What are the risks of progression?

Harnden

Naylor

Shelley

et al. 2008

Cancer

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Clinically localized prostate cancer is associated with a wide variation in biologic behavior, and men with the less aggressive form of the disease may never develop symptoms. There has been a rise in prostate cancer incidence in countries in which the blood test for prostatic-specific antigen (PSA) is common, and concerns have been expressed that this may be because of the increased detection of indolent disease, subjecting these men to unnecessary treatment and associated side effects. For the current review, the authors conducted a systematic evaluation of the literature regarding the outcomes of men who were diagnosed on the basis of a small volume of cancer in prostatic biopsies. The results indicated that, despite differences in study design and reporting, a significant proportion of patients with microfocal cancer, regardless of how it was defined, had adverse pathologic findings and a significant risk of PSA recurrence after undergoing radical prostatectomy. Biochemical and clinical recurrences also were observed after radiotherapy or watchful waiting. The authors concluded that patients with microfocal carcinoma on biopsy should be advised that their disease is not necessarily ''insignificant'' and should be counseled accordingly. Cancer 2008; 112:971-81.

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Section: Resultsmentioning

confidence: 99%

Section: Findings In the Radical Prostatectomy Specimenmentioning

confidence: 99%

The clinical management of patients with a small volume of prostatic cancer on biopsy: What are the risks of progression?

Harnden

Naylor

Shelley

et al. 2008

Cancer

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“…The most common clinical data used to define AS criteria are a Gleason score ≤6, PSA≤10 ng/ml and a clinical stage T1c disease. The PSA density is noted as inclusion criteria in some studies with different reported cut-offs for AS inclusion [6,[13][14]Carter]. Other characteristics to consider include pathological biopsy parameters with a wide variation concerning the AS inclusion criteria.…”

Section: Introductionmentioning

confidence: 99%

“…A cancer involvement of <33% of biopsy cores was retained in the UCSF cohort [16]. Other series included cancers involving <3 cores only [14] and with an extent of cancer in any core <50% [13,17]. Recently, a prospective trial of AS (SURACaP trial) has been opened in France including patients with a tumour length <3 mm in <3 cores [18].…”

Section: Introductionmentioning

confidence: 99%

Pathological Findings and Prostate Specific Antigen Outcomes After Radical Prostatectomy in Men Eligible for Active Surveillance—Does the Risk of Misclassification Vary According to Biopsy Criteria?

et al. 2010

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Word count abstract: Word count text :2 ABSTRACT Purpose: To evaluate and compare the pathological findings and the PSA outcomes after radical prostatectomy (RP) in men eligible for AS, according to 3 different biopsy inclusion criteria. Materials and Methods:The study population included 177 men eligible for AS who fulfilled clinico-biological criteria (Gleason score ≤6, PSA<10, clinical stage T1c) and biopsy criteria as follows: (1) <3 positive cores and <3 mm of total tumour length; (2) and/or <3 positive cores with a cancer involvement <50% in any core; (3) and/or <33% of positive cores. PSA density cut-offs of 15 and 20 ng/ml/gr were also studied among these groups. Pathological findings on RP specimens and biochemical recurrence-free survival (RFS) were studied. Median follow-up was 34 months.Results: Cancers were graded Gleason 7 on RP specimens from 48.3% to 55.4% of cases. The rates of extracapsular extension (ECE) and vesicle seminal invasion (SVI) ranged from 11.2% to 17.5%, and from 1.1% to 1.8%, respectively, regardless of PSA density. The use of PSA density as AS criterion decreased for AS by 1.4-fold and by 2.3-fold the number of men eligible according to the cut-off used. The risk of unfavourable disease (defined as pT3-4 stage and/or a Gleason score≥8) remained between 15% to 19.2% when a PSA density cut-off of 15 ng/ml/gr was used. The risk of overall unfavourable disease was significantly higher in men with a cancer involvement ≥3 mm in initial biopsy compared with men who fulfilled these most stringent biopsy criteria (27.3%, vs 13.5%, respectively; p=0.023). The 3-year biochemical RFS was 91.5% and was not affected by the 3 different AS definitions. Conclusions:Even with the use of a 21-core biopsy protocol, the rate of unfavourable disease on RP specimens remains still elevated in men eligible for AS. Patients must be informed of this risk of misclassification which is about 20% in men who fulfil the less stringent biopsy criteria.

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“…It turned out that in only 64 out of the 293 men an initial AS strategy was chosen. 20 The question thus arises how to deal with overdiagnosis and overtreatment more effectively. A specific biomarker for potentially life-threatening disease would probably solve a large part of the problem; however, no such biomarker is currently available.…”

Section: Overtreatmentmentioning

confidence: 99%

PSA-based prostate cancer screening: the role of active surveillance and informed and shared decision making

Venderbos¹,

Roobol²

2011

Asian J Androl

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Since the first publication describing the identification of prostate-specific antigen (PSA) in the 1960s, much progress has been made. The PSA test changed from being initially a monitoring tool to being also used as a diagnostic tool. Over time, the test has been heavily debated due to its lack of sensitivity and specificity. However, up to now the PSA test is still the only biomarker for the detection and monitoring of prostate cancer. PSA-based screening for prostate cancer is associated with a high proportion of unnecessary testing and overdiagnosis with subsequent overtreatment. In the early years of screening for prostate cancer, high rates of uptake were very important. However, over time the opinion on PSA-based screening has shifted towards the notion of informed choice. Nowadays, it is thought to be unethical to screen men without them being aware of the pros and cons of PSA testing, as well as the fact that an informed choice is related to better patient outcomes. Now, as the results of three major screening studies have been presented and the downsides of screening are becoming better understood, informed choice is becoming more relevant.

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Management and Survival of Screen-Detected Prostate Cancer Patients who Might Have Been Suitable for Active Surveillance

Cited by 70 publications

References 27 publications

The clinical management of patients with a small volume of prostatic cancer on biopsy: What are the risks of progression?

The clinical management of patients with a small volume of prostatic cancer on biopsy: What are the risks of progression?

Pathological Findings and Prostate Specific Antigen Outcomes After Radical Prostatectomy in Men Eligible for Active Surveillance—Does the Risk of Misclassification Vary According to Biopsy Criteria?

PSA-based prostate cancer screening: the role of active surveillance and informed and shared decision making

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