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Active Surveillance is an Appropriate Management Strategy for a Proportion of Men Diagnosed with Prostate Cancer by Prostate Specific Antigen Testing

2015; Lippincott Williams & Wilkins; Volume: 194; Issue: 3 Linguagem: Inglês

10.1016/j.juro.2015.01.089

1527-3792

Stephen Overholser, Matthew Nielsen, Kathleen C. Torkko, Daniel Cwilka, Brandi Weaver, Xiaoyu Shi, Robin J. Leach, Javier Hernández, Tim H.‐M. Huang, Ian M. Thompson, Ian M. Thompson,

Bladder and Urothelial Cancer Treatments

No AccessJournal of UrologyAdult Urology1 Sep 2015Active Surveillance is an Appropriate Management Strategy for a Proportion of Men Diagnosed with Prostate Cancer by Prostate Specific Antigen Testing Stephen Overholser, Matthew Nielsen, Kathleen Torkko, Daniel Cwilka, Brandi Weaver, Xiaoyu Shi, Robin J. Leach, Javier Hernandez, Tim Huang, Ian M. Thompson, and Ian M. Thompson Stephen OverholserStephen Overholser Department of Urology, Cancer Therapy and Research Center, University of Texas Health Science Center at San Antonio, San Antonio, Texas , Matthew NielsenMatthew Nielsen School of Medicine, Cancer Therapy and Research Center, University of Texas Health Science Center at San Antonio, San Antonio, Texas , Kathleen TorkkoKathleen Torkko Department of Pathology, University of Colorado Denver School of Medicine, Aurora, Colorado , Daniel CwilkaDaniel Cwilka School of Medicine, Cancer Therapy and Research Center, University of Texas Health Science Center at San Antonio, San Antonio, Texas , Brandi WeaverBrandi Weaver Department of Urology, Cancer Therapy and Research Center, University of Texas Health Science Center at San Antonio, San Antonio, Texas , Xiaoyu ShiXiaoyu Shi Department of Urology, Cancer Therapy and Research Center, University of Texas Health Science Center at San Antonio, San Antonio, Texas , Robin J. LeachRobin J. Leach Department of Urology, Cancer Therapy and Research Center, University of Texas Health Science Center at San Antonio, San Antonio, Texas , Javier HernandezJavier Hernandez Department of Urology, Cancer Therapy and Research Center, University of Texas Health Science Center at San Antonio, San Antonio, Texas , Tim HuangTim Huang Department of Molecular Medicine, University of Texas Health Science Center at San Antonio, San Antonio, Texas , Ian M. ThompsonIan M. Thompson Department of Urology, Cancer Therapy and Research Center, University of Texas Health Science Center at San Antonio, San Antonio, Texas , and Ian M. ThompsonIan M. Thompson Department of Urology, Cancer Therapy and Research Center, University of Texas Health Science Center at San Antonio, San Antonio, Texas View All Author Informationhttps://doi.org/10.1016/j.juro.2015.01.089AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract Purpose: The purpose of this study was to determine the fraction of men who would qualify for active surveillance in a population based cohort diagnosed with prostate cancer. In those who qualified and subsequently underwent primary treatment with radical prostatectomy, we assessed the rate of upgrading and up staging. Materials and Methods: SABOR is a Clinical and Epidemiologic Center of the EDRN (Early Detection Research Network), NCI (National Cancer Institute), with 3,828 men enrolled at the time of review. Of these men 320 were diagnosed with prostate cancer, of whom 281 had sufficient data for review. These 281 cases were reviewed to determine suitability for active surveillance using 2 sets of criteria. Criteria 1 were prostate specific antigen density less than 15%, 2 or fewer cores involved with cancer, Gleason score 6 or less and cancer involving 50% or less of biopsy volume. Criteria 2 were 4 or fewer cores with Gleason 3 + 3 cancer and only 1 core of Gleason 3 + 4 cancer with up to 15% of core involved with Gleason 3 + 4 disease. For those undergoing radical prostatectomy, we examined rates of up staging and upgrading. Results: Of the 281 patients, 187 (67%) qualified for active surveillance under criteria 1 and/or 2. Treatment data were available on 178 patients, and 74 underwent radical prostatectomy. Using the initial biopsy, 14 men (33.1%) who met criteria 1 and 9 (25%) who met criteria 2 were upgraded and/or up staged on final pathological review. By comparison, 38% of those who did not qualify for active surveillance were upgraded and/or up staged. Conclusions: In a population based cohort, two-thirds of men diagnosed with prostate cancer qualify for active surveillance. Less restricted criteria for surveillance may be appropriate based on similar rates of upgrading/up staging at radical prostatectomy. References 1 : Cancer statistics, 2013. CA Cancer J Clin2013; 63: 11. Google Scholar 2 : Guideline for the management of clinically localized prostate cancer: 2007 update. J Urol2007; 177: 2106. Link, Google Scholar 3 : EAU guidelines on prostate cancer. Part 1: screening, diagnosis, and treatment of clinically localised disease. Eur Urol2011; 59: 61. Google Scholar 4 : NCCN clinical practice guidelines in oncology: prostate cancer. J Natl Compr Canc Netw2010; 8: 162. Google Scholar 5 : National Institutes of Health state-of-the-science conference: role of active surveillance in the management of men with localized prostate cancer. Ann Intern Med2012; 156: 591. 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Google Scholar © 2015 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetailsCited byKelly S, Van Den Eeden S, Hoffman R, Aaronson D, Lobo T, Luta G, Leimpter A, Shan J, Potosky A and Taylor K (2018) Sociodemographic and Clinical Predictors of Switching to Active Treatment among a Large, Ethnically Diverse Cohort of Men with Low Risk Prostate Cancer on Observational ManagementJournal of Urology, VOL. 196, NO. 3, (734-740), Online publication date: 1-Sep-2016.Smith J (2018) This Month in Adult UrologyJournal of Urology, VOL. 194, NO. 3, (609-610), Online publication date: 1-Sep-2015.Dall'Era M and Carroll P (2018) What is the Optimal Way to Select Candidates for Active Surveillance of Prostate Cancer?Journal of Urology, VOL. 194, NO. 3, (615-616), Online publication date: 1-Sep-2015. Volume 194Issue 3September 2015Page: 680-684 Advertisement Copyright & Permissions© 2015 by American Urological Association Education and Research, Inc.Keywordsbiopsyprostate-specific antigenprostatic neoplasmswatchful waitingprostatectomyMetricsAuthor Information Stephen Overholser Department of Urology, Cancer Therapy and Research Center, University of Texas Health Science Center at San Antonio, San Antonio, Texas More articles by this author Matthew Nielsen School of Medicine, Cancer Therapy and Research Center, University of Texas Health Science Center at San Antonio, San Antonio, Texas More articles by this author Kathleen Torkko Department of Pathology, University of Colorado Denver School of Medicine, Aurora, Colorado More articles by this author Daniel Cwilka School of Medicine, Cancer Therapy and Research Center, University of Texas Health Science Center at San Antonio, San Antonio, Texas More articles by this author Brandi Weaver Department of Urology, Cancer Therapy and Research Center, University of Texas Health Science Center at San Antonio, San Antonio, Texas More articles by this author Xiaoyu Shi Department of Urology, Cancer Therapy and Research Center, University of Texas Health Science Center at San Antonio, San Antonio, Texas More articles by this author Robin J. Leach Department of Urology, Cancer Therapy and Research Center, University of Texas Health Science Center at San Antonio, San Antonio, Texas More articles by this author Javier Hernandez Department of Urology, Cancer Therapy and Research Center, University of Texas Health Science Center at San Antonio, San Antonio, Texas More articles by this author Tim Huang Department of Molecular Medicine, University of Texas Health Science Center at San Antonio, San Antonio, Texas More articles by this author Ian M. Thompson Department of Urology, Cancer Therapy and Research Center, University of Texas Health Science Center at San Antonio, San Antonio, Texas Financial interest and/or other relationship with Exosome Diagnostics, Oncocell MDX, Magforce, Myriad Genetics and NanoTX Therapeutics. More articles by this author Ian M. Thompson Department of Urology, Cancer Therapy and Research Center, University of Texas Health Science Center at San Antonio, San Antonio, Texas More articles by this author Expand All Advertisement PDF downloadLoading ...