Pathologic Prostate Cancer Characteristics in Patients Eligible for Active Surveillance: A Head-to-Head Comparison of Contemporary Protocols

Iremashvili, Viacheslav; Pelaez, Lisét; Manoharan, Murugesan; Jordà, Mercè; Rosenberg, Daniel L.; Soloway, Mark S.

doi:10.1016/j.eururo.2012.03.011

Cited by 125 publications

(115 citation statements)

References 19 publications

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“…This trade-off equates with stricter criteria accurately selecting more men with lower-risk disease at the sake of excluding some potential candidates. Misclassification of insignificant disease based on entry criteria range from 22% to 33% of men [21]. Despite these differences, overall estimated 5-yr biochemical recurrence (BCR)-free survival is good, with no differences between groups.…”

Section: Criteria For Active Surveillancementioning

confidence: 99%

“…Most centers do not have strict criteria with regard to patient age, and older men may opt for surveillance despite some higher-risk features, choosing to monitor their disease for early signs of progression when secondary local therapy can still be offered. When different criteria for AS are compared, there is a clear trade-off between sensitivity and specificity for predicting insignificant or organ-confined disease [21]. This trade-off equates with stricter criteria accurately selecting more men with lower-risk disease at the sake of excluding some potential candidates.…”

Section: Criteria For Active Surveillancementioning

confidence: 99%

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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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Section: Criteria For Active Surveillancementioning

confidence: 99%

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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“…This finding is consistent with recent reports assessing the utility of PRIAS criteria in smaller cohorts, cohorts that include patients in the active surveillance era, and cohorts that include intermediate clinical risk. [19][20][21][22][23][24][25][26][27][28][29] While these data suggest that da Silva et al PRIAS criteria are useful, there is clear room for improvement to help best select patients for active surveillance.…”

Section: Discussionmentioning

confidence: 73%

An assessment of Prostate Cancer Research International: Active Surveillance (PRIAS) criteria for active surveillance of clinically low-risk prostate cancer patients

Silva

Cagiannos

Lavallée

et al. 2017

CUAJ

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Introduction: Active surveillance is a strategy to delay or prevent treatment of indolent prostate cancer. The Prostate Cancer Research International: Active Surveillance (PRIAS) criteria were developed to select patients for prostate cancer active surveillance. The objective of this study was to compare pathological findings from PRIAS-eligible and PRIAS-ineligible clinically low-risk prostate cancer patients. Methods: A D'Amico low-risk cohort of 1512 radical prostatectomy patients treated at The Ottawa Hospital or Memorial Sloan Kettering Cancer Centre between January 1995 and December 2007 was reviewed. Pathological outcomes (pT3 tumours, Gleason sum ≥7, lymph node metastases, or a composite) and clinical outcomes (prostate-specific antigen [PSA] recurrence, secondary cancer treatments, and death) were compared between PRIAS-eligible and PRIAS-ineligible cohorts. Results: The PRIAS-eligible cohort (n=945) was less likely to have Gleason score ≥7 (odds ratio [OR] 0.61; 95% confidence interval [CI] 0.49-0.75), pT3 (OR 0.41; 95% CI 0.31-0.55), nodal metastases (OR 0.37; 95% CI 0.10-1.31), or any adverse feature (OR 0.56; 95% CI 0.45-0.69) compared to the PRIAS-ineligible cohort. The probability of any adverse pathology in the PRIAS-eligible cohort was 41% vs. 56% in the PRIAS-ineligible cohort. At median followup of 3.7 years, 72 (4.8%) patients had a PSA recurrence, 24 (1.6%) received pelvic radiation, and 13 (0.9%) received androgen deprivation. No difference was detected for recurrence-free and overall survival between groups (recurrence hazard ratio [HR] 0.71; 95% CI 0.46-1.09 and survival HR 0.72; 95% CI 0.36-1.47). Conclusions: Low-risk prostate cancer patients who met PRIAS eligibility criteria are less likely to have higher-risk cancer compared to those who did not meet at least one of these criteria.

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“…Two recent series showed similar findings of a large discrepancy in the proportion of patients eligible for different AS protocols, varying from 16% to 63% and 28% to 69%. 18,19 We demonstrated that although all AS protocols aim to select low-risk prostate cancer, the heterogeneity between them can be quite large. Clinicians need to be vigilant before adopting any of the AS protocols for their patients when further data from comparative analyses among different protocols are unavailable.…”

Section: Discussionmentioning

confidence: 99%

“…The proportion of patients who were eligible for AS protocols in our study was lower than that in previous series. 18,19 This may be because some patients with localised prostate cancer were treated with radiotherapy. The proportion of patients who can be selected in different AS protocols will be affected by the proportion of patients who undergo radiotherapy instead of surgery.…”

Section: Discussionmentioning

confidence: 99%