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A single centre experience of active surveillance as management strategy for low-risk prostate cancer in Ireland

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Abstract

Introduction

Active surveillance (AS) is a management strategy for addressing the widely acknowledged problem of over diagnosis and over treatment of clinically indolent prostate cancer.

Methods

A total of 80 patients were enrolled on the AS program in our institution between January 2008 and June 2012. All data were collected prospectively in a secure database.

Results

The mean age of patients enrolled was 62.7 years (range 50–72). Median PSA at enrolment was 5.6 ng/mL (range 1.2–13.4). The mean follow-up was 32 months (range 2–54). In total, 85 % of patients had a repeat biopsy after 1-year with 30 % having another biopsy after 3 years. Overall, 45 % of patients remain on AS. In the remainder; 42.5 % of patients have been removed from AS for definitive treatment, while 8.75 % of patients are now on watchful waiting, 2.5 % of patients self discharged from the program and one patient died of cardiovascular disease. The prostate cancer specific survival rate is 100 %. Reasons for removal from AS and referral for treatment were; 67.6 % of patients had upgrade of disease on repeat biopsy, 17.6 % of patients had PSA progression, 11.8 % patients had progression of disease on MRI, and one patient developed a palpable nodule. Regarding definitive treatment; 52.9 % of patients have been for referred for external beam radiotherapy, 14.7 % have been referred for brachytherapy, 29.4 % have been referred for surgery and one patient has refused definitive treatment.

Conclusion

Our findings to date support active surveillance as a valid strategy for early, localised prostate cancer.

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References

  1. Center MM, Jemal A, Lortet-Tieulent J et al (2012) International variation in prostate cancer incidence and mortality rates. Eur Urol 61:1079–1092

    Article  PubMed  Google Scholar 

  2. Ferlay J, Shin HR, Bray F, Forman D, Mathers C, Parkin DM (2010) Estimates of worldwide burden of cancer in 2008: GLOBOCAN 2008. Int J Can 15(127):2893–2917

    Article  Google Scholar 

  3. Prostate cancer UK––Incidence statistics. 2011 [cited; Available from: http://info.cancerresearchuk.org/cancerstats/types/prostate/incidence/]

  4. National Cancer Registry of Ireland––Recent trends in prostate cancer. 2010 [cited; Available from: http://www.ncri.ie/pubs/pubfiles/prostate%20trends.pdf]

  5. Bono AV (2004) The global state of prostate cancer: epidemiology and screening in the second millennium. BJU Int 94(Suppl 3):1–2

    Article  PubMed  Google Scholar 

  6. Schroder FH, Hugosson J, Roobol MJ et al (2009) Screening and prostate-cancer mortality in a randomized european study. N Engl J Med 26(360):1320–1328

    Article  Google Scholar 

  7. Wilt TJ, Brawer MK, Jones KM et al (2012) Radical prostatectomy versus observation for localized prostate cancer. N Engl J Med 19(367):203–213

    Article  Google Scholar 

  8. D’Amico AV (2011) Risk-based management of prostate cancer. N Engl J Med 14(365):169–171

    Article  Google Scholar 

  9. D’Amico AV, Moul J, Carroll PR, Sun L, Lubeck D, Chen MH (2003) Cancer-specific mortality after surgery or radiation for patients with clinically localized prostate cancer managed during the prostate-specific antigen era. J Clin Oncol 1(21):2163–2172

    Article  Google Scholar 

  10. Boorjian SA, Karnes RJ, Rangel LJ, Bergstralh EJ, Blute ML (2008) Mayo Clinic validation of the D’amico risk group classification for predicting survival following radical prostatectomy. J Urol 179:1354–1360 discussion 60–1

    Article  PubMed  Google Scholar 

  11. Epstein JI, Walsh PC, Carmichael M, Brendler CB (1994) Pathologic and clinical findings to predict tumor extent of non-palpable (stage T1c) prostate cancer. JAMA 2(271):368–374

    Article  Google Scholar 

  12. Bastian PJ, Mangold LA, Epstein JI, Partin AW (2004) Characteristics of insignificant clinical T1c prostate tumors. A contemporary analysis. Cancer 1(101):2001–2005

    Article  Google Scholar 

  13. Choo R, Klotz L, Danjoux C et al (2002) Feasibility study: watchful waiting for localized low to intermediate grade prostate carcinoma with selective delayed intervention based on prostate specific antigen, histological and/or clinical progression. J Urol 167:1664–1669

    Article  PubMed  Google Scholar 

  14. Moore CM, Ridout A, Emberton M (2013) The role of MRI in active surveillance of prostate cancer. Curr Opin Urol 23(3):261–267

    PubMed  Google Scholar 

  15. Dall’Era MA, Albertsen PC, Bangma C et al (2012) Active surveillance for prostate cancer: a systematic review of the literature. Eur Urol 62:976–983

    Article  PubMed  Google Scholar 

  16. Oken MM, Creech RH, Tormey DC et al (1982) Toxicity and response criteria of the eastern cooperative oncology group. Am J Clin Oncol 5:649–655

    Article  CAS  PubMed  Google Scholar 

  17. Forde JC, Marignol L, Blake O et al (2012) Standardization of assay methods reduces variability of total PSA measurements: an Irish study. BJU Int 110:644–650

    Article  CAS  PubMed  Google Scholar 

  18. Heidenreich A, Bellmunt J, Bolla M et al (2011) EAU guidelines on prostate cancer. Part I: screening, diagnosis, and treatment of clinically localised disease. Actas Urol Esp 35:501–514

    CAS  PubMed  Google Scholar 

  19. Thompson I, Thrasher JB, Aus G et al (2007) Guideline for the management of clinically localized prostate cancer: 2007 update. J Urol 177:2106–2131

    Article  PubMed  Google Scholar 

  20. Adamy A, Yee DS, Matsushita K et al (2011) Role of prostate specific antigen and immediate confirmatory biopsy in predicting progression during active surveillance for low risk prostate cancer. J Urol 185:477–482

    Article  PubMed Central  PubMed  Google Scholar 

  21. Berglund RK, Masterson TA, Vora KC, Eggener SE, Eastham JA, Guillonneau BD (2008) Pathological upgrading and up staging with immediate repeat biopsy in patients eligible for active surveillance. J Urol 180:1964–1967 discussion 7–8

    Article  PubMed Central  PubMed  Google Scholar 

  22. Soloway MS MM, Rosenberg D, Kava B (2011) Active surveillance for prostate cancer: an update of the Miami experience [abstract]. 31st Congress of the Societe Internationale D’Urologie. Berlin, Germany

  23. Soloway MS, Soloway CT, Eldefrawy A, Acosta K, Kava B, Manoharan M (2010) Careful selection and close monitoring of low-risk prostate cancer patients on active surveillance minimizes the need for treatment. Eur Urol 58:831–835

    Article  PubMed  Google Scholar 

  24. Klotz L, Zhang L, Lam A, Nam R, Mamedov A, Loblaw A (2010) Clinical results of long-term follow-up of a large, active surveillance cohort with localized prostate cancer. J Clin Oncol 1(28):126–131

    Article  Google Scholar 

  25. Krakowsky Y, Loblaw A, Klotz L (2010) Prostate cancer death of men treated with initial active surveillance: clinical and biochemical characteristics. J Urol 184:131–135

    Article  PubMed  Google Scholar 

  26. van den Bergh RC, Roemeling S, Roobol MJ et al (2009) Outcomes of men with screen-detected prostate cancer eligible for active surveillance who were managed expectantly. Eur Urol 55:1–8

    Article  PubMed  Google Scholar 

  27. Tosoian JJ, Trock BJ, Landis P et al (2011) Active surveillance program for prostate cancer: an update of the johns hopkins experience. J Clin Oncol 1(29):2185–2190

    Article  Google Scholar 

  28. Ayres BE, Montgomery BS, Barber NJ et al (2012) The role of transperineal template prostate biopsies in restaging men with prostate cancer managed by active surveillance. BJU Int 109:1170–1176

    Article  PubMed  Google Scholar 

  29. van As NJ, Norman AR, Thomas K et al (2008) Predicting the probability of deferred radical treatment for localised prostate cancer managed by active surveillance. Eur Urol 54:1297–1305

    Article  PubMed  Google Scholar 

  30. Duffield AS, Lee TK, Miyamoto H, Carter HB, Epstein JI (2009) Radical prostatectomy findings in patients in whom active surveillance of prostate cancer fails. J Urol 182:2274–2278

    Article  PubMed  Google Scholar 

  31. NICE (2008) Prostate Cancer: Diagnosis and Treatment. [cited; Available from: http://www.nice.org.uk/nicemedia/pdf/CG58NICEGuideline.pdf

  32. Lawrentschuk N, Klotz L (2011) Active surveillance for low-risk prostate cancer: an update. Nat Rev Urol 8:312–320

    Article  PubMed  Google Scholar 

  33. Turkbey B, Mani H, Shah V et al (2011) Multi-parametric 3T prostate magnetic resonance imaging to detect cancer: histopathological correlation using prostatectomy specimens processed in customized magnetic resonance imaging based molds. J Urol 186:1818–1824

    Article  PubMed  Google Scholar 

  34. Morgan VA, Riches SF, Thomas K et al (2011) Diffusion-weighted magnetic resonance imaging for monitoring prostate cancer progression in patients managed by active surveillance. Br J Radiol 84:31–37

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  35. Giles SL, Morgan VA, Riches SF, Thomas K, Parker C, deSouza NM (2011) Apparent diffusion coefficient as a predictive biomarker of prostate cancer progression: value of fast and slow diffusion components. AJR Am J Roentgenol 196:586–591

    Article  PubMed  Google Scholar 

  36. Mullins JK, Bonekamp D, Landis P et al (2013) Multi-parametric magnetic resonance imaging findings in men with low-risk prostate cancer followed using active surveillance. BJU Int 111(7):1037–1045

    Article  PubMed Central  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Urology, Beaumont Hospital, Dublin, Ireland

    J. C. Forde, P. J. Daly, S. White, G. P. Smyth & R. E. Power

  2. Department of Radiology, Beaumont Hospital, Dublin, Ireland

    M. Morrin

  3. Department of Radiation Oncology, Beaumont Hospital, Dublin, Ireland

    B. D. P. O’Neill

Authors
  1. J. C. Forde
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  2. P. J. Daly
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  3. S. White
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  4. M. Morrin
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  5. G. P. Smyth
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  6. B. D. P. O’Neill
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  7. R. E. Power
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Correspondence to J. C. Forde.

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Forde, J.C., Daly, P.J., White, S. et al. A single centre experience of active surveillance as management strategy for low-risk prostate cancer in Ireland. Ir J Med Sci 183, 377–382 (2014). https://doi.org/10.1007/s11845-013-1024-9

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  • DOI: https://doi.org/10.1007/s11845-013-1024-9

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