Updated clinical results of active surveillance of very-low-risk prostate cancer in Korean men: 8 years of follow-up

Abstract

PurposeUpdate and reanalysis of our experience of active surveillance (AS) for prostate cancer (PCa) in Korea.Materials and MethodsA prospective, single-arm, cohort study was initiated in January 2008. Patients were selected according to the following criteria: Gleason sum ≤6 with single positive core with ≤30% core involvement, clinical stage≤T1c, prostate-specific antigen (PSA)≤10 ng/mL, and negative magnetic resonance imaging (MRI) results. Follow-up was by PSA measurement every 6 months, prostate biopsies at 1 year and then every 2–3 years, and MRI every year.ResultsA total of 80 patients were treated with AS. Median follow-up was 52 months (range, 6–96 months). Of them, 39 patients (48.8%) discontinued AS for various reasons (17, disease progression; 9, patient preference; 10, watchful waiting due to old age; 3, follow-up loss; 2, death). The probability of progression was 14.0% and 42.9% at 1 and 3 years, respectively. Overall survival was 97.5%. PCa-specific survival was 100%. Progression occurred in 5 of 7 patients (71.4%) with a prostate volume less than 30 mL, 7 of 40 patients (17.5%) with a prostate volume of 30 to 50 mL, and 5 of 33 patients (15.2%) with a prostate volume of 50 mL or larger. There were 8 detectable positive lesions on follow-up MRI. Of them, 6 patients (75%) had actual progressed disease.ConclusionsSmall prostate volume was associated with a tendency for cancer progression. MRI was helpful and promising for managing AS. Nevertheless, regular biopsies should be performed. AS is a safe and feasible treatment option for very-low-risk PCa in Korea. However, AS should continue to be used in carefully selected patients.

The prognostic value of the pretreatment serum albumin to globulin ratio for predicting adverse pathology in patients undergoing radical prostatectomy for prostate cancer

“…Approximately 14,561 new PCa cases and 2,040 PCa-related deaths were reported in Korea in 2020 [ 2 ]. In addition to an increase in PCa-associated mortality [ 3 ], the incidence of PCa has been increasing in Korea owing to a modernized environmental lifestyle, more westernized dietary habits, medical advances in laboratory diagnosis, gradual implementation and widespread application of prostate-specific antigen (PSA) screening, and enhanced prostate biopsy skill [ 4 5 6 ].…”

A Higher Ratio of Serum Calcium to Magnesium Is Associated With Aggressive Clinicopathological Characteristics in the Patients Who Underwent Radical Prostatectomy

“…3 Several aspects, including environmental factors, changes in dietary habits, medical advances in laboratory diagnosis, and campaigns for prostate-specific antigen (PSA) screening, are associated with the increased incidence of PCa. 4,5 In the United States, PCa is the most prevalent cancer among men and the second leading cause of cancer-related mortality. 6 Contemporary guidelines recommend that treatment decisions should be based on tumor features, baseline PSA levels, patient age, comorbidity, life expectancy, and quality of life.…”

A single-center long-term experience of active surveillance for prostate cancer: 15 years of follow-up

“…Meanwhile, guidelines for Korean populations have not yet been established and differ between institutions. Ha et al [6] (2017) published an 8-year follow-up report with the most stringent criteria of biopsy GS ≤6, clinical- Single center 15-year experience of AS in Korea stage ≤T1c, PSA ≤10 ng/mL, one bipsy core, and negative MRI findings, whereas Jeong et al [7] (2018) developed new selection criteria to include the clinical T2a stage, as well as a PSA density of <0.15 ng/mL/mL, and ≤2 positive cores among 10 or more total biopsy cores, with maximal core involvement in any core ≤20% [6]. Both criteria were stricter than contemporary Western studies, with relatively better outcomes in the rate of unfavorable disease and recurrencefree survival.…”

“…The current criteria for AS are based on Western studies, and validations using Korean populations must be made to identify the optimal criteria for patient selection. However, previous studies conducted in Korea have mainly used only the strictest criteria, and while they produced promising results in terms of outcome, it is questionable whether such stringent selection is feasible in actual clinical practice or accurately represents patient needs and wants to defer active treatment [ 6 7 ]. A broader enrollment further offers the chance to avoid overtreatment in low-risk PCa, but further validation is required in long-term cohorts.…”