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Active surveillance prostate

Chee W Ong, Pamela Maxwell, Muhammad A Alvi, Stephen McQuaid, David Waugh, Ian Mills, Manuel Salto-Tellez
Accurate identification of intermediate risk (Gleason 3 + 4 = 7) prostate cancer patients with low risk of disease progression is an unmet challenge in treatment decision making. Here we describe a gene signature that could guide clinicians in the selection of patients with intermediate stage clinically localized prostate cancer for active surveillance. We examined six major drivers of aggressive disease - PTEN, MYC, RB1, TP53, AURKA, AR - by immunohistochemistry in a focused (N = 69) cohort predominantly consisting of intermediate risk prostate cancer...
April 2018: Journal of Pathology. Clinical Research
J Rubio-Briones, A Borque-Fernando, L M Esteban-Escaño, S Martínez-Breijo, R Medina-López, V Hernández
BACKGROUND: Our main objective was to report the current use of active surveillance in Spain and to identify areas for potential improvement. METHODS: A questionnaire generated by the Platform for Multicentre Studies of the Spanish Urology Association (AEU/PIEM/2014/0001, NCT02865330) was sent to all associate researchers from January to March 2016. The questionnaire included 7 domains covering various aspects of active surveillance. RESULTS: Thirty-three of the 41 associate researchers responded to the questionnaire...
April 13, 2018: Actas Urologicas Españolas
Daniel W Lin, E David Crawford, Thomas Keane, Brent Evans, Julia Reid, Saradha Rajamani, Krystal Brown, Alexander Gutin, Jonathan Tward, Peter Scardino, Michael Brawer, Steven Stone, Jack Cuzick
BACKGROUND: A combined clinical cell-cycle risk (CCR) score that incorporates prognostic molecular and clinical information has been recently developed and validated to improve prostate cancer mortality (PCM) risk stratification over clinical features alone. As clinical features are currently used to select men for active surveillance (AS), we developed and validated a CCR score threshold to improve the identification of men with low-risk disease who are appropriate for AS. METHODS: The score threshold was selected based on the 90th percentile of CCR scores among men who might typically be considered for AS based on NCCN low/favorable-intermediate risk criteria (CCR = 0...
April 11, 2018: Urologic Oncology
Nicole E Curci, Brian R Lane, Prasad R Shankar, Sabrina L Noyes, Andrew K Moriarty, Anthony Kubat, Chris Brede, Jeffrey S Montgomery, Gregory B Auffenberg, David C Miller, James E Montie, Arvin K George, Matthew S Davenport
OBJECTIVE: To evaluate the integration of 3T non-endorectal-coil multiparametric prostate MRI (mpMRI) at two high-volume practices that routinely use mpMRI in the setting of active surveillance. MATERIALS AND METHODS: This was an IRB-approved, HIPAA-compliant, dual-institution retrospective cohort study. Subjects undergoing 3T mpMRI without endorectal coil at either study institution over a 13-month period (8/1/2015-8/31/2016) were selected based on pre-defined criteria: clinical T1/T2 Gleason 6 prostate cancer, PSA<15 ng/mL, ≥40 years-old, mpMRI within 2 years of prostate biopsy, PI-RADS v2 score assigned...
April 10, 2018: Urology
Arnauld Villers, Jonathan Olivier
No abstract text is available yet for this article.
April 9, 2018: European Urology
R J Bryant, B Yang, Y Philippou, K Lam, M Obiakor, J Ayers, V Chiocchia, F Gleeson, R MacPherson, C Verrill, P Sooriakumaran, F C Hamdy, S F Brewster
OBJECTIVES: To determine whether replacement of protocol-driven repeat prostate biopsy (PB) with multiparametric magnetic resonance imaging (mpMRI) +/- targeted repeat prostate biopsy (TB) in evaluating men on active surveillance (AS) for low-volume low- to intermediate-risk prostate cancer (PCa) altered the likelihood or time to treatment, or reduced the number of repeat biopsies required to trigger treatment. PATIENTS AND METHODS: 445 patients underwent AS from 2010-2016 at our institution with median follow-up of 2...
April 12, 2018: BJU International
Samrad Ghavimi, Hamidreza Abdi, Jennifer Waterhouse, Richard Savdie, Silvia Chang, Alison Harris, Lindsay Machan, Martin Gleave, Alan So, Larry Goldenberg, Peter C Black
INTRODUCTION: The natural history of prostatic lesions identified on multiparametric magnetic resonance imaging (mpMRI) is largely unknown. We aimed to describe changes observed over time on serial MRI. METHODS: All patients with ≥2 MRI studies between 2008 and 2015 at our institution were identified. MRI progression was defined as an increase in Prostate Imaging Reporting and Data System (PI-RADS; version 2) or size of existing lesions, or the appearance of a new lesion PIRADS ≥4...
April 6, 2018: Canadian Urological Association Journal, Journal de L'Association des Urologues du Canada
Michael A Bell, Jeffrey D Campbell, Gregory Joice, Nikolai A Sopko, Arthur L Burnett
Historically, testosterone and prostate cancer have been demonstrated to have a positive association leading providers to forgo testosterone replacement therapy (TRT) in men with concurrent histories of hypogonadism and prostate cancer. This paradigm has been gradually shifting with our evolving understanding of the relationship between testosterone and prostate cancer and the gaining popularity of the saturation model. Newer data suggests improved quality of life for men with hypogonadism after TRT leading to a more tempered view of the effects of this treatment and its risk in prostate cancer...
March 22, 2018: World Journal of Men's Health
Larissa J Vos, Clement K Ho, Bryan J Donnelly, J Dean Reuther, Marc Kerba
INTRODUCTION: Treatment decisions in localized prostate cancer are complicated by the available choices. A rapid-access cancer clinic (RAC) has been unique to Calgary, AB, since 2007. This RAC offers multidisciplinary prostate cancer education by a urologist, medical oncologist, and radiation oncologist. It is hypothesized that treatment utilization data from decisions taken at RAC may serve to benchmark the appropriateness of treatment decisions on a population level. METHODS: Records of patients with clinically localized prostate cancer in Alberta between October 1, 2007 and September 30, 2009 were reviewed with ethics approval...
March 19, 2018: Canadian Urological Association Journal, Journal de L'Association des Urologues du Canada
Lena Ansmann, Nicola Winter, Nicole Ernstmann, Axel Heidenreich, Lothar Weissbach, Jan Herden
OBJECTIVES: To compare Health-related Quality of Life (HRQOL) between patients with localized Prostate Cancer (PCa) in the active surveillance (AS) group and the radical prostatectomy (RP) group, since evidence shows that both groups have similar oncological outcomes. Thus, comparative findings on the patients' HRQOL are becoming even more important to allow for informed treatment decision-making. PATIENTS AND METHODS: HAROW (Hormonal therapy, Active Surveillance, Radiation, Operation, Watchful Waiting) is a prospective, observational study designed to collect data for different treatment options for newly diagnosed patients with localised prostate cancer under real-life conditions...
March 30, 2018: BJU International
Netty Kinsella, Pär Stattin, Declan Cahill, Christian Brown, Anna Bill-Axelson, Ola Bratt, Sigrid Carlsson, Mieke Van Hemelrijck
CONTEXT: Despite support for active surveillance (AS) as a first treatment choice for men with low-risk prostate cancer (PC), this strategy is largely underutilised. OBJECTIVE: To systematically review barriers and facilitators to selecting and adhering to AS for low-risk PC. EVIDENCE ACQUISITION: We searched PsychINFO, PubMed, Medline 2000-now, Embase, CINAHL, and Cochrane Central databases between 2002 and 2017 using the Preferred Reporting Items for Systematic Review and Meta-analysis (PRISMA) statement...
March 26, 2018: European Urology
Ken Mastris, Louis Denis
Prostate cancer (PCa) patients selected for active surveillance (AS) have received information on prostate cancer PCa, treatment, knew their serum prostate specific antigen (PSA), a digital rectal examination (DRE) done and could rely on their set of biopsies to be labelled as low grade, low volume disease (by adding a radiographic/ultrasonic measurement). They usually react euphoric to the selection hoping to escape invasive curative treatment and its side-effects. Unfortunately, this positive feeling waivers in front of uncertainty in the follow-up including biopsies...
February 2018: Translational Andrology and Urology
Nuno M Pereira-Azevedo, Lionne D F Venderbos
eHealth and mobile health (mHealth) offer patients, healthcare providers, researchers, and policy makers new potential to improve wellness, practice prevention and reduce suffering from diseases. While the eHealth market is growing to an expected US $26 billion, its potential in the field of Urology is still underused. Research has shown that currently only 176 apps (of the 300,000 medical apps available) were found in the Apple App Store and Google Play Store, of which 20 were prostate cancer related. Three good examples of eHealth/mHealth applications are the Rotterdam Prostate Cancer Risk Calculator (RPCRC) website and app, the Prostate cancer Research International Active Surveillance (PRIAS) website and the Follow MyPSA app for men on active surveillance for prostate cancer: they are tools with a clear vision that offer true added value in daily clinical practice and which positively influence healthcare beyond borders...
February 2018: Translational Andrology and Urology
Julia Menichetti, Riccardo Valdagni, Lara Bellardita
Several studies have been conducted on the quality of life (QoL) in men with low risk prostate cancer (PCa) who choose active surveillance (AS). While recent reviews have shown a lack of consistency among the available QoL-studies, a few key points have been identified, including decision-making (DM)-related issues and their potential effect on QoL. The importance of this theme has also been recently highlighted by the international task force of the European School of Oncology. However, to our knowledge, there are no studies that have specifically marshalled scientific knowledge on the association between DM and QoL among men with low-risk PCa undergoing AS...
February 2018: Translational Andrology and Urology
Stacy Loeb, Jeffrey J Tosoian
The use of active surveillance (AS) is increasing for favorable-risk prostate cancer. However, there remain challenges in patient selection for AS, due to the limitations of current clinical staging. In addition, monitoring protocols relying on serial biopsies is invasive and presents risks such as infection. For these reasons, there is substantial interest in identifying markers that can be used to improve AS selection and monitoring. In this article, we review the evidence on serum, urine and tissue markers in AS...
February 2018: Translational Andrology and Urology
Ivo G Schoots, Daniel F Osses, Frank-Jan H Drost, Jan F M Verbeek, Sebastiaan Remmers, Geert J L H van Leenders, Chris H Bangma, Monique J Roobol
Background: The fear of undergrading prostate cancer (PCa) in men on active surveillance (AS) have led to strict criteria for monitoring, which have resulted in good long-term cancer-specific survival, proving the safety of this approach. Reducing undergrading, MRI-targeted biopsies are increasingly used in men with low-risk disease despite their undefined role yet. The objective of this study is to investigate the rate of upgrading using MRI-targeted biopsies in men with low-risk disease on AS, stratified on the basis of PI-RADS and PSA-density, with the aim to reduce potential unnecessary repeat biopsy procedures...
February 2018: Translational Andrology and Urology
Francesco Giganti, Caroline M Moore
In recent years, active surveillance has been increasingly adopted as a conservative management approach to low and sometimes intermediate risk prostate cancer, to avoid or delay treatment until there is evidence of higher risk disease. A number of studies have investigated the role of multiparametric magnetic resonance imaging (mpMRI) in this setting. MpMRI refers to the use of multiple MRI sequences (T2-weighted anatomical and functional imaging which can include diffusion-weighted imaging, dynamic contrast enhanced imaging, spectroscopy)...
February 2018: Translational Andrology and Urology
Daan Nieboer, Anirudh Tomer, Dimitris Rizopoulos, Monique J Roobol, Ewout W Steyerberg
Active surveillance (AS) is an important treatment modality aiming to reduce the overtreatment of patients with prostate cancer (PCa) who have a low risk of disease reclassification. After enrolling in AS patients are actively monitored using different diagnostic tests (e.g., prostate specific-antigen, digital rectal exams (DREs), medical imaging, and prostate biopsies). Biopsy is the most burdensome test. We aimed to review schedules for monitoring men on AS. We compare fixed versus risk based dynamic monitoring, where biopsies are scheduled during follow-up based on dynamic risk predictions...
February 2018: Translational Andrology and Urology
Frank-Jan H Drost, Antti Rannikko, Riccardo Valdagni, Tom Pickles, Yoshiyuki Kakehi, Sebastiaan Remmers, Henk G van der Poel, Chris H Bangma, Monique J Roobol
Background: Active surveillance (AS) for low-risk prostate cancer (PCa) appears to provide excellent long-term PCa-specific and overall survival. The choice for AS as initial treatment is mainly based on avoiding side effects from invasive treatment; but AS entails regular check-ups and the possibility of still having to switch or deciding to switch to invasive treatment. Here, we assessed the long-term follow-up data from AS in real life clinical practices. Methods: Data from the first 500 men, enrolled in PRIAS before July 2008 by 30 centers across 8 countries, were analyzed to provide long-term follow-up results...
February 2018: Translational Andrology and Urology
Netty Kinsella, Jozien Helleman, Sophie Bruinsma, Sigrid Carlsson, Declan Cahill, Christian Brown, Mieke Van Hemelrijck
In the last decade, active surveillance (AS) has emerged as an acceptable choice for low-risk prostate cancer (PC), however there is discordance amongst large AS cohort studies with respect to entry and monitoring protocols. We systematically reviewed worldwide AS practices in studies reporting ≥5 years follow-up. We searched PubMed and Medline 2000-now and identified 13 AS cohorts. Three key areas were identified: (I) patient selection; (II) monitoring protocols; (III) triggers for intervention-(I) all studies defined clinically localised PC diagnosis as T2b disease or less and most agreed on prostate-specific antigen (PSA) threshold (<10 µg/L) and Gleason score threshold (3+3)...
February 2018: Translational Andrology and Urology
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