Prostate‐specific antigen doubling time as a progression criterion in an active surveillance programme for patients with localized prostate cancer

Thomsen, Frederik Birkebæk; Christensen, Ib Jarle; Brasso, Klaus; Røder, Martin Andreas; Iversen, Peter

doi:10.1111/bju.12367

Cited by 13 publications

(11 citation statements)

References 31 publications

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“…These findings underline the relevance of a second opinion histopathological evaluation or discussion in uro‐pathological conferences in borderline cases. Still, compared with the considerable uncertainty and variation in the estimation of PSA doubling time , our present results indicate that the definition of ‘progression’, when based on the histopathological evaluation, is more reliable than when based on PSA kinetics alone. Gleason score reclassification between diagnostic and re‐biopsies may represent an actual disease progression with deteriorated prognosis and a subsequent survival benefit from curative treatment.…”

Section: Discussionmentioning

confidence: 58%

“…Dynamic parameters including PSA kinetics, histopathological findings on re‐biopsies, and clinical tumour category (cT) are used to monitor selected patients with prostate cancer managed by active surveillance (AS) . However, recent reports have indicated that PSA kinetics are unreliable as progression criteria owing to the low specificity and wide CIs of the estimates .…”

Section: Introductionmentioning

confidence: 99%

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Repeated biopsies in patients with prostate cancer on active surveillance: clinical implications of interobserver variation in histopathological assessment

et al. 2014

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ObjectiveTo investigate the clinical implications of interobserver variation in the assessment of re-biopsies obtained during active surveillance (AS) of prostate cancer. Patients and MethodsIn all, 107 patients with low-risk prostate cancer with 93 diagnostic biopsy sets and 109 re-biopsy sets were included. The International Society of Urological Pathology 2005 Gleason scoring system was used for the histopathological assessment of all biopsies. Three different definitions of histopathological progression were applied. Unweighted and linear weighted Kappa (κ) statistics were used to compare the interobserver agreement. ResultsThe overall Gleason score agreement was 68.8% with a weighted κ of 0.670. The interobserver agreement was 79.6% for meeting the AS selection criteria. According to the three progression definitions applied, overall agreement was between 80.7% and 89.0% with weighted κ values of 0.746-0.791. Treatment recommendations would have changed in up to 10.1% (95% confidence interval 5.4-17.7%) of the 109 re-biopsy sets. ConclusionKappa statistics showed strong agreement between the histological evaluations. However, up to 10% of patients on AS would receive a different treatment recommendation depending upon which histopathological evaluation of re-biopsies was used for treatment planning.

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Section: Discussionmentioning

confidence: 58%

Section: Introductionmentioning

confidence: 99%

Repeated biopsies in patients with prostate cancer on active surveillance: clinical implications of interobserver variation in histopathological assessment

et al. 2014

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“…Results from the existing active surveillance protocols also report similar proportions of patients who had a higher Gleason score or larger tumor burden at the time of the first repeated biopsy after diagnosis . Importantly, of the components typically included in active surveillance, findings at repeat biopsy may be the strongest indicator of adverse findings at radical prostatectomy …”

Section: Active Surveillance: Expectant Management With Curative Intentmentioning

confidence: 80%

Expectant management for men with early stage prostate cancer

Filson

Marks

Litwin

2015

CA A Cancer J Clinicians

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https://www.wileyhealthlearning.com/acs.aspx Since the dissemination of prostate‐specific antigen screening, most men with prostate cancer are now diagnosed with localized, low‐risk prostate cancer that is unlikely to be lethal. Nevertheless, nearly all of these men undergo primary treatment with surgery or radiation, placing them at risk for longstanding side effects, including erectile dysfunction and impaired urinary function. Active surveillance and other observational strategies (ie, expectant management) have produced excellent long‐term disease‐specific survival and minimal morbidity for men with prostate cancer. Despite this, expectant management remains underused for men with localized prostate cancer. In this review, various approaches to the expectant management of men with prostate cancer are summarized, including watchful waiting and active surveillance strategies. Contemporary cancer‐specific and health care quality‐of‐life outcomes are described for each of these approaches. Finally, contemporary patterns of use, potential disparities in care, and ongoing research and controversies surrounding expectant management of men with localized prostate cancer are discussed. CA Cancer J Clin 2015;65:264–282. © 2015 American Cancer Society.

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“…PSA velocity can correlate with upgrading on prostatic re-biopsies and prostatectomy but the correlation with PSA doubling time is poor. [24][25][26][27][28] Active surveillance patients had 3-4 monthly PSA checks in our study. Similar to previous studies, PSA velocity has been used as a trigger, intentionally or unintentionally, for template biopsies in our study as the median PSA for initial transrectal ultrasound guided prostatic biopsies is 6.1 ng/ml and template biopsies is 6.7 ng/ml.…”

Section: Discussionmentioning

confidence: 99%

Active surveillance: transperineal biopsies and evaluation of multi-parametric magnetic resonance imaging

Bhat

Abbaraju

et al. 2019

Int Surg J

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Background: Active surveillance has emerged as an acceptable choice for low-risk prostate cancer patients and is defined as a treatment strategy of close monitoring through PSA, digital rectal examination, imaging and prostate biopsy, with conversion to curative treatment if progression occurs. An ideal tool for risk-stratification would detect aggressive cancers and exclude such men from taking up active surveillance in the first place.Methods: We retrospectively reviewed patients who underwent transperineal template biopsies from January 2016 till December 2018. All the patients had been classified as low grade prostate cancer after conventional trans-rectal ultrasound guided biopsy and enrolled in AS after discussion in hospital MDM. As per NICE guidelines all patients underwent multi-parametric magnetic resonance imaging (MRI). All suspicious lesions were assigned a PIRAD score; this was followed by Trans-perineal prostate biopsy. 142 patients were on active surveillance and underwent mapping transperineal template biopsies and cognitive target biopsies. 130 of them had multi-parametric MRI prior to the biopsies.Results: In 52% of cases the histology was upgraded. In 34 (24%) the cancer was upgraded to Gleason 3+4 and 39 (28%) it was upgraded to scores higher than Gleason 3+4. Only 64 (45%) patients continued on active surveillance post-template biopsies due to significant upgrading of histology.Conclusions: We advocate combination of MRI and an early transperineal template guided prostatic biopsies for intermediate risk prostate cancer, multiple core involvement, higher PIRAD grades and suspicious prostate on digital rectal examination in order to re-stage the initial disease and provide better safety for this cohort of patients.

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Prostate‐specific antigen doubling time as a progression criterion in an active surveillance programme for patients with localized prostate cancer

Abstract: The uncertainty of calculated PSAdt during AS leads to a significant risk of patients being misclassified in terms of risk of progression, which limits the use of PSAdt in the management of patients on AS.

Cited by 13 publications

References 31 publications

Repeated biopsies in patients with prostate cancer on active surveillance: clinical implications of interobserver variation in histopathological assessment

Repeated biopsies in patients with prostate cancer on active surveillance: clinical implications of interobserver variation in histopathological assessment

Expectant management for men with early stage prostate cancer

Active surveillance: transperineal biopsies and evaluation of multi-parametric magnetic resonance imaging

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