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Active Surveillance for Favorable-Risk Prostate Cancer

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Abstract

Active surveillance is becoming a more widely accepted management strategy in men with low-risk localized prostate cancer. This is in recognition of the knowledge that the majority of men with such cancer are likely to die from other causes. The obvious benefits of active surveillance are reduced morbidity by delaying or avoiding radical gland therapy. These advantages should be balanced against appropriate selection criteria and triggers for moving to radical therapy while on active surveillance. The optimal method to identify the small number of men who will progress using clinical, biopsy, and imaging data is yet to be defined. Nevertheless, active surveillance is an appealing management option in selected men with prostate cancer and represents a solution to the significant problem of overdiagnosis of clinically insignificant disease which accompanies PSA screening.

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Abbreviations

AS:

Active surveillance

PSA:

Prostate-specific antigen

References

  1. Tarone RE, Chu KC, Brawley OW. Implications of stage-specific survival rates in assessing recent declines in prostate cancer mortality rates. Epidemiology. 2000;11(2):167–70.

    Article  PubMed  CAS  Google Scholar 

  2. Hussain S, et al. Secular trends in prostate cancer mortality, incidence and treatment: England and Wales, 1975–2004. BJU Int. 2008;101(5):547–55.

    Article  PubMed  Google Scholar 

  3. Collin SM, et al. Prostate-cancer mortality in the USA and UK in 1975–2004: an ecological study. Lancet Oncol. 2008;9(5):445–52.

    Article  PubMed  Google Scholar 

  4. Hankey BF, et al. Cancer surveillance series: interpreting trends in prostate cancer – part I: evidence of the effects of screening in recent prostate cancer incidence, mortality, and survival rates. J Natl Cancer Inst. 1999;91(12):1017–24.

    Article  PubMed  CAS  Google Scholar 

  5. Rohde V, Weidner W, Katalinic A. Decrease in prostate cancer incidence and mortality in Germany – effects of opportunistic PSA screening or more? Urol Int. 2009;83(2):134–40.

    Article  PubMed  CAS  Google Scholar 

  6. Chu KC, Tarone RE, Freeman HP. Trends in prostate cancer mortality among black men and white men in the United States. Cancer. 2003;97(6):1507–16.

    Article  PubMed  Google Scholar 

  7. Gofrit ON, et al. The Will Rogers phenomenon in urological oncology. J Urol. 2008;179(1):28–33.

    Article  PubMed  Google Scholar 

  8. Auprich M, et al. External validation of urinary PCA3-based nomograms to individually predict prostate biopsy outcome. Eur Urol. 2010;58:727–32.

    Article  PubMed  Google Scholar 

  9. Amsellem-Ouazana D, et al. Negative prostatic biopsies in patients with a high risk of prostate cancer. Is the combination of endorectal MRI and magnetic resonance spectroscopy imaging (MRSI) a useful tool? A preliminary study. Eur Urol. 2005;47(5):582–6.

    Article  PubMed  Google Scholar 

  10. Klotz L, Nam R. Active surveillance with selective delayed intervention for favourable risk prostate cancer: clinical experience and a “number needed to treat” analysis. Eur Urol Suppl. 2006;5:479–86.

    Article  Google Scholar 

  11. Sanda MG, et al. Quality of life and satisfaction with outcome among prostate-cancer survivors. N Engl J Med. 2008;358(12):1250–61.

    Article  PubMed  CAS  Google Scholar 

  12. Klotz L. Active surveillance for favorable risk prostate cancer: what are the results, and how safe is it? Semin Radiat Oncol. 2008;18(1):2–6.

    Article  PubMed  Google Scholar 

  13. Lindner U, et al. Image guided photothermal focal therapy for localized prostate cancer: phase I trial. J Urol. 2009;182(4):1371–7.

    Article  PubMed  CAS  Google Scholar 

  14. Klotz L. Active surveillance for favorable-risk prostate cancer: who, how and why? Nat Clin Pract Oncol. 2007;4(12):692–8.

    Article  PubMed  Google Scholar 

  15. Bacon CG, et al. The impact of cancer treatment on quality of life outcomes for patients with localized prostate cancer. J Urol. 2001;166(5):1804–10.

    Article  PubMed  CAS  Google Scholar 

  16. Galbraith ME, Ramirez JM, Pedro LW. Quality of life, health outcomes, and identity for patients with prostate cancer in five different treatment groups. Oncol Nurs Forum. 2001;28(3):551–60.

    PubMed  CAS  Google Scholar 

  17. Litwin MS, et al. Mental health in men treated for early stage prostate carcinoma: a posttreatment, longitudinal quality of life analysis from the cancer of the prostate strategic urologic research endeavor. Cancer. 2002;95(1):54–60.

    Article  PubMed  Google Scholar 

  18. Arredondo SA, et al. Watchful waiting and health related quality of life for patients with localized prostate cancer: data from CaPSURE. J Urol. 2004;172(5 Pt 1):1830–4.

    Article  PubMed  Google Scholar 

  19. Steineck G, et al. Quality of life after radical prostatectomy or watchful waiting. N Engl J Med. 2002;347(11):790–6.

    Article  PubMed  Google Scholar 

  20. Dall’Era MA, et al. Active surveillance for early-stage prostate cancer: review of the current literature. Cancer. 2008;112(8):1650–9.

    Article  PubMed  Google Scholar 

  21. Barocas DA, et al. What percentage of patients with newly diagnosed carcinoma of the prostate are candidates for surveillance? An analysis of the CaPSURE database. J Urol. 2008;180(4):1330–4; discussion 1334–5.

    Article  PubMed  Google Scholar 

  22. van den Bergh RC, et al. Outcomes of men with screen-detected prostate cancer eligible for active surveillance who were managed expectantly. Eur Urol. 2009;55:1–8. Epub 2008 Sept 17.

    Article  PubMed  Google Scholar 

  23. National Comprehensive Cancer Network. NCCN clinical practice guidelines in oncology: prostate cancer V.3.2010. 2010. available at www.nccn.org. Accessed July 2010.

  24. Heidenreich A, et al. Guidelines on prostate cancer. Eur Assoc Urol. 2007. available at www.uroweb.org/guidelines/online-guidelines, Accessed July 2010.

  25. Lee SE, et al. Application of the Epstein criteria for prediction of clinically insignificant prostate cancer in Korean men. BJU Int. 2010;105(11):1526–30.

    Article  PubMed  Google Scholar 

  26. Lawrentschuk N, Klotz L. Active surveillance for favorable-risk prostate cancer: a short review. Korean J Urol. 2010;51(10):665–70.

    Article  PubMed  Google Scholar 

  27. Raz O, et al. MRI for men undergoing active surveillance or with rising PSA and negative biopsies. Nat Rev Urol. 2010;7(10):543–51.

    Article  PubMed  Google Scholar 

  28. Turkbey B, et al. Prostate cancer: value of multiparametric MR imaging at 3 T for detection – histopathologic correlation. Radiology. 2010;255(1):89–99.

    Article  PubMed  Google Scholar 

  29. Kurhanewicz J, et al. Multiparametric magnetic resonance imaging in prostate cancer: present and future. Curr Opin Urol. 2008;18(1):71–7.

    Article  PubMed  Google Scholar 

  30. Lawrentschuk N, et al. ‘Prostatic evasive anterior tumours’: the role of magnetic resonance imaging. BJU Int. 2010;105:1231–6. Epub 2009 Oct 8.

    Article  PubMed  Google Scholar 

  31. van den Bergh RC, et al. Gleason score 7 screen-detected prostate cancers initially managed expectantly: outcomes in 50 men. BJU Int. 2009;103(11):1472–7.

    Article  PubMed  Google Scholar 

  32. Klotz L, et al. Clinical results of long-term follow-up of a large, active surveillance cohort with localized prostate cancer. J Clin Oncol. 2009;28(1):126–31.

    Article  PubMed  Google Scholar 

  33. Bastian PJ, et al. Insignificant prostate cancer and active surveillance: from definition to clinical implications. Eur Urol. 2009;55(6):1321–30.

    Article  PubMed  Google Scholar 

  34. van As NJ, et al. A study of diffusion-weighted magnetic resonance imaging in men with untreated localised prostate cancer on active surveillance. Eur Urol. 2009;56:981–7. Epub 2008 Dec 6.

    Article  PubMed  Google Scholar 

  35. Cabrera AR, et al. Prostate cancer: is inapparent tumor at endorectal MR and MR spectroscopic imaging a favorable prognostic finding in patients who select active surveillance? Radiology. 2008;247(2):444–50.

    PubMed  Google Scholar 

  36. de Souza NM, et al. Diffusion-weighted magnetic resonance imaging: a potential non-invasive marker of tumour aggressiveness in localized prostate cancer. Clin Radiol. 2008;63(7):774–82.

    Article  Google Scholar 

  37. Franiel T, et al. Pharmacokinetic MRI of the prostate: parameters for differentiating low-grade and high-grade prostate cancer. Rofo. 2009;181(6):536–42.

    Article  PubMed  CAS  Google Scholar 

  38. Shukla-Dave A, et al. The utility of magnetic resonance imaging and spectroscopy for predicting insignificant prostate cancer: an initial analysis. BJU Int. 2007;99(4):786–93.

    Article  PubMed  CAS  Google Scholar 

  39. Chodak GW, et al. Results of conservative management of clinically localized prostate cancer. N Engl J Med. 1994;330(4):242–8.

    Article  PubMed  CAS  Google Scholar 

  40. Dall’Era MA, et al. Active surveillance for the management of prostate cancer in a contemporary cohort. Cancer. 2008;112(12):2664–70.

    Article  PubMed  Google Scholar 

  41. Kakehi Y, et al. Prospective evaluation of selection criteria for active surveillance in Japanese patients with stage T1cN0M0 prostate cancer. Jpn J Clin Oncol. 2008;38(2):122–8.

    Article  PubMed  Google Scholar 

  42. Carter HB, et al. Expectant management of prostate cancer with curative intent: an update of the Johns Hopkins experience. J Urol. 2007;178(6):2359–64; discussion 2364–5.

    Article  PubMed  Google Scholar 

  43. Roemeling S, et al. Active surveillance for prostate cancers detected in three subsequent rounds of a screening trial: characteristics, PSA doubling times, and outcome. Eur Urol. 2007;51(5):1244–50; discussion 1251.

    Article  PubMed  Google Scholar 

  44. Soloway MS, et al. Active surveillance; a reasonable management alternative for patients with prostate cancer: the Miami experience. BJU Int. 2008;101(2):165–9.

    PubMed  Google Scholar 

  45. Hardie C, et al. Early outcomes of active surveillance for localized prostate cancer. BJU Int. 2005;95(7):956–60.

    Article  PubMed  Google Scholar 

  46. Patel MI, et al. An analysis of men with clinically localized prostate cancer who deferred definitive therapy. J Urol. 2004;171(4):1520–4.

    Article  PubMed  Google Scholar 

  47. Lawrentschuk N, Klotz L. Active surveillance for low-risk prostate cancer- an update. Nat Rev Urol. 2011;8:312–20.

    Article  PubMed  Google Scholar 

  48. van den Bergh RC, et al. Is delayed radical prostatectomy in men with low-risk screen-detected prostate cancer associated with a higher risk of unfavorable outcomes? Cancer. 2010;116(5):1281–90.

    Article  PubMed  Google Scholar 

  49. Sokoll LJ, et al. A multicenter evaluation of the PCA3 molecular urine test: pre-analytical effects, analytical performance, and diagnostic accuracy. Clin Chim Acta. 2008;389(1–2):1–6.

    Article  PubMed  CAS  Google Scholar 

  50. Krakowsky Y, Loblaw A, Klotz L. Prostate cancer death of men treated with initial active surveillance: clinical and biochemical characteristics. J Urol. 2010;184(1):131–5.

    Article  PubMed  Google Scholar 

  51. Thompson IM, et al. The influence of finasteride on the development of prostate cancer. N Engl J Med. 2003;349(3):215–24.

    Article  PubMed  CAS  Google Scholar 

  52. Andriole GL, et al. Effect of dutasteride on the risk of prostate cancer. N Engl J Med. 2010;362(13):1192–202.

    Article  PubMed  CAS  Google Scholar 

  53. Fleshner N, et al. Delay in the progression of low-risk prostate cancer: rationale and design of the reduction by dutasteride of clinical progression events in expectant management (REDEEM) trial. Contemp Clin Trials. 2007;28(6):763–9.

    Article  PubMed  CAS  Google Scholar 

  54. Lindner U, Lawrentschuk N, Trachtenberg J. Image guidance for focal therapy of prostate cancer. World J Urol. 2010;28(6):727–34.

    Article  PubMed  CAS  Google Scholar 

  55. Ploussard G, et al. The role of biopsy core number in selecting prostate cancer patients for active surveillance. Eur Urol Suppl. 2010;9:53.

    Article  Google Scholar 

  56. Klotz L, et al. Observation or radical treatment in patients with prostate cancer. 2007. US National Institutes of Health, ClinicalTrials.gov: NCT00499174. Accessed 15 July 2010.

    Google Scholar 

  57. Hamdy F. Active surveillance, radical prostatectomy, or radiation therapy in treating patients with localized prostate cancer. 2008. US National Institutes of Health, ClinicalTrials.gov: NCT00632983. Accessed 30 July 2010.

    Google Scholar 

  58. van den Bergh RC, et al. Prospective validation of active surveillance in prostate cancer: the PRIAS study. Eur Urol. 2007;52(6):1560–3.

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Division of Urology, Department of Surgery, Sunnybrook Health Sciences Centre, University of Toronto, 2075 Bayview Avenue, MG408, Toronto, ON, M4N 3M5, Canada

    Nathan Lawrentschuk M.B.B.S., Ph.D., FRACS & Laurence Klotz M.D., FRCS (C)

  2. Ludwig Institute for Cancer Research, Melbourne, VIC, Australia

    Nathan Lawrentschuk M.B.B.S., Ph.D., FRACS

  3. Department of Surgery, Austin Hospital, University of Melbourne, Studley Road, Melbourne, VIC, 3084, Australia

    Nathan Lawrentschuk M.B.B.S., Ph.D., FRACS

Authors
  1. Nathan Lawrentschuk M.B.B.S., Ph.D., FRACS
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  2. Laurence Klotz M.D., FRCS (C)
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Corresponding author

Correspondence to Nathan Lawrentschuk M.B.B.S., Ph.D., FRACS .

Editor information

Editors and Affiliations

  1. New York Presbyterian Hospital, Brady Urologic Health Center, Weill Cornell Medical Center, East 68th Street 525, New York, 10021, New York, USA

    Ashutosh Tewari

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Lawrentschuk, N., Klotz, L. (2013). Active Surveillance for Favorable-Risk Prostate Cancer. In: Tewari, A. (eds) Prostate Cancer: A Comprehensive Perspective. Springer, London. https://doi.org/10.1007/978-1-4471-2864-9_51

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  • DOI: https://doi.org/10.1007/978-1-4471-2864-9_51

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