[Active Surveillance for Prostate Cancer]

Overview

Journal Urologe A

Specialty Urology

Date 2008 Feb 15

PMID 18273597

Citations 6

Authors

M Graefen

S Ahyai

R Heuer

G Salomon

T Schlomm

H Isbarn

L Budaus

H Heinzer

H Huland

Affiliations

Soon will be listed here.

Abstract

Active surveillance is a valuable treatment option in patients with newly diagnosed low-risk prostate cancer. Studies considering a watchful waiting approach showed favourable cancer-specific survival rates in such patients and it is assumed that patients benefit from a definitive therapy if life expectancy exceeds 10-15 years. Therefore active surveillance is especially valuable in older men and in patients with an elevated comorbidity profile. Precise identification of histologically and clinically insignificant prostate cancers is still not possible today. Active surveillance includes regular PSA measurements combined with follow-up biopsies; however, no standardized protocol exists so far. Histological progression in the follow-up biopsy and PSA elevation are the most important criteria for initiating definitive therapy. Today only a minority of low-risk patients join an active surveillance protocol and a substantial proportion of these men leave such a protocol early without evidence of progression. The psychological burden of living with an untreated cancer seems to be responsible for this. Active surveillance has the potential to lead to undertreatment as there is some evidence that prolonged treatment delay might adversely affect outcome of definitive therapy.

Citing Articles

Survey on the practice of active surveillance for prostate cancer from the Middle East.

El Sebaaly R, Mansour M, Labban M, Jaafar R, Armache A, Mukherji D Prostate Int. 2020; 8(1):41-48.

PMID: 32257977 PMC: 7125368. DOI: 10.1016/j.prnil.2019.11.001.

Qualitative and Quantitative Requirements for Assessing Prognostic Markers in Prostate Cancer.

Burdelski C, Matuszewska A, Kluth M, Koop C, Grupp K, Steurer S Microarrays (Basel). 2016; 3(2):137-58.

PMID: 27600340 PMC: 5003445. DOI: 10.3390/microarrays3020137.

[Active surveillance for low-risk prostate cancer].

Herlemann A, Stief C Urologe A. 2016; 55(2):269-81.

PMID: 26831055 DOI: 10.1007/s00120-015-0025-x.

Overexpression of thymidylate synthase (TYMS) is associated with aggressive tumor features and early PSA recurrence in prostate cancer.

Burdelski C, Strauss C, Tsourlakis M, Kluth M, Hube-Magg C, Melling N Oncotarget. 2015; 6(10):8377-87.

PMID: 25762627 PMC: 4480759. DOI: 10.18632/oncotarget.3107.

[Documentation quality of histopathology reports of prostate needle biopsies: a snapshot].

Biesterfeld S Urologe A. 2014; 53(11):1644-50.

PMID: 25272987 DOI: 10.1007/s00120-014-3584-3.

References

Cupp M, Bostwick D, Myers R, Oesterling J . The volume of prostate cancer in the biopsy specimen cannot reliably predict the quantity of cancer in the radical prostatectomy specimen on an individual basis. J Urol. 1995; 153(5):1543-8. View

Panagiotou I, Beer T, Hsieh Y, Mori M, Peters L, Klein T . Predictors of delayed therapy after expectant management for localized prostate cancer in the era of prostate-specific antigen. Oncology. 2004; 67(3-4):194-202. DOI: 10.1159/000081317. View

Noguchi M, Stamey T, McNeal J, Yemoto C . Relationship between systematic biopsies and histological features of 222 radical prostatectomy specimens: lack of prediction of tumor significance for men with nonpalpable prostate cancer. J Urol. 2001; 166(1):104-9; discussion 109-10. View

Albertsen P, Hanley J, Fine J . 20-year outcomes following conservative management of clinically localized prostate cancer. JAMA. 2005; 293(17):2095-101. DOI: 10.1001/jama.293.17.2095. View

Klotz L . Active surveillance for favorable-risk prostate cancer: who, how and why?. Nat Clin Pract Oncol. 2007; 4(12):692-8. DOI: 10.1038/ncponc0966. View

Walz J, Gallina A, Perrotte P, Jeldres C, Trinh Q, Hutterer G . Clinicians are poor raters of life-expectancy before radical prostatectomy or definitive radiotherapy for localized prostate cancer. BJU Int. 2007; 100(6):1254-8. DOI: 10.1111/j.1464-410X.2007.07130.x. View

Meng M, Elkin E, Harlan S, Mehta S, Lubeck D, Carroll P . Predictors of treatment after initial surveillance in men with prostate cancer: results from CaPSURE. J Urol. 2003; 170(6 Pt 1):2279-83. DOI: 10.1097/01.ju.0000094190.46523.b2. View

Barry M, Albertsen P, Bagshaw M, Blute M, Cox R, Middleton R . Outcomes for men with clinically nonmetastatic prostate carcinoma managed with radical prostactectomy, external beam radiotherapy, or expectant management: a retrospective analysis. Cancer. 2001; 91(12):2302-14. DOI: 10.1002/1097-0142(20010615)91:12<2302::aid-cncr1262>3.3.co;2-g. View

Elgamal A, Van Poppel H, Van de Voorde W, Van Dorpe J, Oyen R, Baert L . Impalpable invisible stage T1c prostate cancer: characteristics and clinical relevance in 100 radical prostatectomy specimens--a different view. J Urol. 1997; 157(1):244-50. DOI: 10.1016/s0022-5347(01)65337-0. View

10.

Wu H, Sun L, Moul J, Wu H, McLeod D, Amling C . Watchful waiting and factors predictive of secondary treatment of localized prostate cancer. J Urol. 2004; 171(3):1111-6. DOI: 10.1097/01.ju.0000113300.74132.8b. View

11.

Graefen M, Walz J, Chun K, Schlomm T, Haese A, Huland H . Reasonable delay of surgical treatment in men with localized prostate cancer--impact on prognosis?. Eur Urol. 2005; 47(6):756-60. DOI: 10.1016/j.eururo.2005.02.004. View

12.

Klotz L . Active surveillance for prostate cancer: for whom?. J Clin Oncol. 2005; 23(32):8165-9. DOI: 10.1200/JCO.2005.03.3134. View

13.

Irwin M, Trapasso J . Identification of insignificant prostate cancers: analysis of preoperative parameters. Urology. 1994; 44(6):862-7; discussion 867-8. DOI: 10.1016/s0090-4295(94)80171-1. View

14.

Epstein J, Chan D, Sokoll L, Walsh P, Cox J, Rittenhouse H . Nonpalpable stage T1c prostate cancer: prediction of insignificant disease using free/total prostate specific antigen levels and needle biopsy findings. J Urol. 1998; 160(6 Pt 2):2407-11. View

15.

Sakr W, Haas G, Cassin B, Pontes J, Crissman J . The frequency of carcinoma and intraepithelial neoplasia of the prostate in young male patients. J Urol. 1993; 150(2 Pt 1):379-85. DOI: 10.1016/s0022-5347(17)35487-3. View

16.

Khan M, Partin A, Carter H . Expectant management of localized prostate cancer. Urology. 2003; 62(5):793-9. DOI: 10.1016/s0090-4295(03)00653-8. View

17.

McLaren D, McKenzie M, Duncan G, Pickles T . Watchful waiting or watchful progression?: Prostate specific antigen doubling times and clinical behavior in patients with early untreated prostate carcinoma. Cancer. 1998; 82(2):342-8. DOI: 10.1002/(sici)1097-0142(19980115)82:2<349::aid-cncr15>3.0.co;2-z. View

18.

Augustin H, Hammerer P, Graefen M, Erbersdobler A, Blonski J, Palisaar J . Insignificant prostate cancer in radical prostatectomy specimen: time trends and preoperative prediction. Eur Urol. 2003; 43(5):455-60. DOI: 10.1016/s0302-2838(03)00139-8. View

19.

Patel M, DeConcini D, Lopez-Corona E, Ohori M, Wheeler T, Scardino P . An analysis of men with clinically localized prostate cancer who deferred definitive therapy. J Urol. 2004; 171(4):1520-4. DOI: 10.1097/01.ju.0000118224.54949.78. View

20.

Choo R, Klotz L, Danjoux C, Morton G, Deboer G, Szumacher E . 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. 2002; 167(4):1664-9. View