Findings May Help Predict Outcomes Of Active Surveillance
Active surveillance is used to monitor slow-growing, low-risk, or localized prostate cancer rather than treating it straight away. It typically involves regular prostate-specific antigen screenings, prostate exams, imaging studies, and repeat biopsies to carefully monitor prostate cancer misclassification, growth, or progression without compromising long-term outcomes. The aim of active surveillance is to avoid or delay unnecessary treatment and its side effects.
Active surveillance is increasingly viewed as the preferred approach for the management of lower-risk prostate cancer. However, there is limited information on how long patients remain on active surveillance before converting to active or definitive treatment, such as surgery or radiation therapy.
Dr. Catalona and colleagues analyzed data on 6,775 patients with prostate cancer managed with active surveillance at 28 medical centers in a National Cancer Institute-sponsored Prostate SPORE project study. Sixty-eight percent of the men were classified as having low-risk disease, based on factors including the Gleason grade, which assesses the aggressiveness of cancer cell behavior tumor stage, which reflects how far cancer has spread and the number of positive biopsy specimens .
Article: Factors Associated with Time to Conversion from Active Surveillance to Treatment for Prostate Cancer in a Multi-Institutional Cohort
Tools To Help You Decide
The Predict Prostate tool can help you decide between monitoring and more radical treatment. It is for men whose prostate cancer hasn’t spread.
It can’t tell you exactly what is going to happen in the future, but it gives you an idea about the differences in survival between the different treatment options. The tool works less well for men with a very high PSA or those with a fast growing or large tumour.
To be able to use the tool you need to know the following about your cancer:
- PSA level
Low Risk Of Cancer Spread On Active Surveillance For Early Prostate Cancer
Men undergoing active surveillance for prostate cancer have very low rates – one percent or lessof cancer spread or death from prostate cancer, according to a recent study published in The Journal of Urology, an official journal of the American Urological Association .
“In the long-term, active surveillance is a safe and viable option for men with low-risk and carefully selected intermediate-risk prostate cancer,” according to the report by senior author Peter R. Carroll, MD, MPH, of University of California, San Francisco and colleagues.
During active surveillance, prostate cancer is carefully monitored for signs of progression through regular prostate-specific antigen screening, prostate exams, imaging and repeat biopsies. If symptoms develop, or if tests indicate the cancer is more aggressive, active treatment such as surgery or radiation may be warranted.
New data on outcomes of active surveillance
The goal of active surveillance is to avoid or delay the side effects of treatment in men with favorable-risk disease without compromising such long-term outcomes as survival or metastasis. Dr. Carroll and his team set out to assess the long-term outcomes of men on active surveillance for prostate cancer to determine which, if any, prognostic factors could predict the risk of metastases.
Results showed risk of metastases during long-term active surveillance was affected by three factors:
Explore further
You May Like: What Age To Screen For Prostate Cancer
What Are The Benefits Of Active Surveillance
One of the benefits of active surveillance is that you may be able to avoid treating a cancer that may never be a problem. You also can delay or avoid surgery or radiation and its side effects. The short-term and long-term side effects from having surgery or radiation are serious. They include having trouble getting erections, having urinary problems like not being able to control your bladder, and having bowel problems such as diarrhea or rectal pain.
Another benefit is that you can keep your current quality of life and keep doing the activities you enjoy, at least for a time. Your overall well-being your physical, mental, and sexual health and your relationships are all part of your quality of life.
For men with low-risk localized prostate cancer who choose active surveillance, the chance of their cancer spreading is low. One study that compared active monitoring , surgery, and radiation in men with localized prostate cancer found that the risk of dying was about the same no matter what men chose.footnote 2
Efficacy Of The Treatment
Three patients developed biochemical failure, thus providing a 7-year actual biochemical failure-free survival rate of 99.1% . Biochemical failure was observed exclusively in cases with distant metastasis: two cases with lymph node metastasis and one case with bone metastasis, thus yielding a 7-year freedom from clinical failure rate of 99.1% . We observed eight deaths, but there was no death from prostate cancer, thus yielding a 7-year cause-specific survival rate of 100%, and an OS rate of 98.4% .
Kaplan-Meier BFFS, FFCF, CSS and OS. A Kaplan-Meier BFFS: BFFS rate is 99.1% at 7 years. B Kaplan-Meier FFCF: FFCF rate is 99.1% at 7 years. C Kaplan-Meier CSS: CSS rate is 100% at 7 years. D Kaplan-Meier OS: OS rate is 98.4%.
Recommended Reading: External Beam Radiation Treatment For Prostate Cancer
Low Risk Prostate Cancer And An Opportunity Lost: More Activity Required In Active Surveillance
Men who are being monitored may be more open to interventions for improving their general health and quality of life
Prostate cancer is the most frequently registered cancer in Australian men, with an estimated 17 729 new diagnoses in 2018.1 For the 25% who are diagnosed with low risk disease, active surveillance is now the recommended management strategy, as their cancer may never progress.2 Avoiding or at least postponing radical treatment reduces the quality of life risks associated with surgery or radiation therapy. However, there is no evidence-based consensus about the optimal approach to surveillance, and practices differ between countries with regard to the type, frequency, and sequence of follow-up.3 AS differs from watchful waiting in that it has a curative intent watchful waiting involves less intense routine monitoring, intervening only when symptoms appear. One standard approach to AS recommends prostate-specific antigen assessment every 36 months, a digital rectal examination at least once a year, and at least one biopsy within 12 months of diagnosis, followed by serial biopsy every 25 years.
The full article is accessible to AMA members and paid subscribers. Login to read more or purchase a subscription now.
- 1 Cancer Council NSW, Sydney, NSW
- 2 University of Adelaide, Adelaide, SA
- 3 Royal Adelaide Hospital, Adelaide, SA
Correspondence:Acknowledgements:Competing interests:
Definition Of Clinically Insignificant Prostate Cancer
Low-risk prostate cancer has been defined by DAmico as Gleason score of 6 or less, PSA less than 10 mg/ml, and a tumor that is either non-palpable or only palpable in less than half of one lobe of the prostate . Very low-risk disease has been defined by Epstein as low-risk patients who have only one or two positive cores, no more than 50% involvement of any one core, and a PSA density of < 0.15 . This definition is based on data demonstrating that these patients have a very high likelihood of clinically insignificant prostate cancer. A key concept is the pathologic definition of clinically insignificant prostate cancer. For 30 years, this has been defined as Gleason score of 6 or less, prostate cancer with a prostate tumor volume < 0.5 cc, based on work by T. Stamey on cystoprostatectomy specimens . There is much evidence that this is an overly stringent definition. Recently, the ERSPC group performed a similar analysis based on the ERSPC patients . Their conclusion was that the threshold for clinically insignificant disease was a cancer volume < 1.3 cc. This has major implications. It means that a better test for prostate cancer would ignore small volume disease, and identify cancers of 1.3 cc or greater.
Also Check: Can You Have Radiation Twice For Prostate Cancer
The Natural History And Molecular Biology Of Low Grade Prostate Cancer
Prostate cancer develops with age in the majority of men, including those from all races and regions. In Caucasians, the chance of harboring prostate cancer is approximately the same as ones age thirty percent of men in their 30s, 40% in their 40s, 80% in their 80s . Most of these are microfoci and low grade, particularly in younger men. The high prevalence of microfocal prostate cancer has been confirmed in autopsy studies of Caucasians, Asians, and other ethnic groups going back more than 50 years. A recent autopsy study in Japanese and Russian men who died of other causes showed that overall 35% of both groups had prostate cancer, and 50% of the cancers in Japanese men aged > 70 were Gleason score 7 or above .
Key Points To Remember
- With active surveillance, you can choose to wait to start treatment, such as surgery or radiation. Some men will never need surgery or radiation. And others will be able to delay having surgery or radiation until tests show that their cancer is growing.
- Surgery or radiation may be used to remove or destroy the cancer right away. But in many cases, the cancer would never have caused you problems. And having these treatments may not cure the cancer.
- Surgery and radiation can cause serious side effects, such as erection, bladder, and bowel problems. And these can have a big impact on your quality of life.
- There is a chance that your prostate cancer may grow during active surveillance. But you will have frequent checkups and tests to watch for any changes. And if the cancer grows, it can still be successfully treated.
- Men with low-risk localized prostate cancer and some men with medium-risk localized prostate cancer have a very low risk of dying from prostate cancer. This is true no matter what approach they choose.
Recommended Reading: Mri Of The Prostate A Practical Approach
British Columbia Specific Information
Prostate cancer is a cancer of the prostate gland, which is a gland that produces the milky liquid found in semen. Patients with low-risk prostate cancer have a 10-year cancer survival rate of over 99%.
You are considered a low-risk patient if you have a PSA value that is equal or less than 10 nanograms per millilitre , a Gleason score that is equal or less than 6, and your cancer stage is T1c/T2a. PSA is your prostate specific antigen measured by a blood test, the Gleason score indicates how aggressive the cancer is by looking at tissue biopsy results, and the cancer stage describes how much the cancer has spread.
Active surveillance has been developed to allow for careful management of men with low-risk prostate cancer. For more information, visit BC Cancer Agency – Prostate.
Top of the pageDecision Point
You may want to have a say in this decision, or you may simply want to follow your doctor’s recommendation. Either way, this information will help you understand what your choices are so that you can talk to your doctor about them.
What Remains Unansweredinformationen About $cms: If$$cms: Valueconvert2$$cms: End: If$
The ProtecT trial has one important weakness: The participants have only been observed for ten years so far. But it would only be possible to draw any reliable conclusions about the pros and cons of the three treatment approaches after 15 or 20 years.
Surgery is the only treatment for which there is currently conclusive long-term data gathered over a period of 23 years. This data comes from a Scandinavian study that compared the surgical removal of the prostate with the watchful waiting approach. But only about one third of the men in this study had low-risk prostate cancer. So its not possible to draw any reliable conclusions about the long-term pros and cons of the current standard treatment options for low-risk prostate cancer.
The ProtecT trial also has another limitation: The check-ups that men had in the “active surveillance” group were different from the current standard approach in Germany. In the ProtecT trial, the men had a PSA test every 3 months in the first year, and then every 6 to 12 months after that. If the PSA levels were too high or if the men developed symptoms such as problems urinating, they had further tests. In Germany, men who have abnormal PSA test results are also advised to have regular biopsies . This is meant to increase the likelihood of finding out soon enough if the cancer progresses, but it can also be more distressing.
Read Also: Does Prostate Cancer Come Back
Prostate Cancer Risk Factors
A risk factor is anything that raises your risk of getting a disease such as cancer. Different cancers have different risk factors. Some risk factors, like smoking, can be changed. Others, like a persons age or family history, cant be changed.
But having a risk factor, or even several, does not mean that you will get the disease. Many people with one or more risk factors never get cancer, while others who get cancer may have had few or no known risk factors.
Researchers have found several factors that might affect a mans risk of getting prostate cancer.
‘observation’ Best For Low
20-year study found little difference in death rates, more complications with surgery
HealthDay Reporter
THURSDAY, July 13, 2017 — Men with early stage prostate cancer who have surgery to remove their tumor do not live longer than those who receive no treatment at all, a long-running clinical trial has concluded.
At the same time, nearly one in three men who had the surgery wound up with long-term complications, such as urinary incontinence and erectile dysfunction, said lead researcher Dr. Timothy Wilt. He is a clinical investigator with the Minneapolis Veterans Affairs Health Care System.
Based on these findings, cancer experts should revise clinical guidelines so most men with low-risk prostate cancer receive no treatment, Wilt said.
Instead, doctors should simply track the progress of their patient’s slow-growing cancer by asking about signs and symptoms of disease progression.
“Our results demonstrate that for the large majority of men with localized prostate cancer, selecting observation for their treatment choice can help them live a similar length of life, avoid death from prostate cancer and prevent harms from surgical treatment,” Wilt said.
“These patients have an excellent prognosis without surgery,” Andriole said. “This study confirms that aggressive treatment usually is not necessary.”
In fact, this was the first randomized trial comparing surgery against no treatment since PSA testing became common, Wilt said.
Recommended Reading: Can You Get An Erection Without A Prostate
Who Remained Prostate Cancer Free
More than 80% of all Low Risk patients will do well with any treatment without fear of recurrence or their cancer returning. However, when selecting a course of action, consultations are recommended with a urologist or surgeon, radiation oncologist and medical oncologist. Different treatments have different results and side effects. It is important to understand the potential impact each treatment can have on your quality of life after treatment.
When comparing treatments, it is important to understand how effective the treatment or combination of treatments, are in keeping patients in remission. Prostate cancer recurrence is determined by periodic monitoring or testing PSA levels, following treatment. If you remain in remission for 10-15 years after prostate cancer treatment, it is very unlikely that the cancer will ever return. Click on ‘Get the Study’, to obtain your copy of Foundation’s work. Share the Study with your Doctor as you choose your treatment plan.
More than 80% of all Low Risk patients will do well with any treatment without fear of recurrence or their cancer returning. However, when selecting a course of action, consultations are recommended with a urologist or surgeon, radiation oncologist and medical oncologist. Different treatments have different results and side effects. It is important to understand the potential impact each treatment can have on your quality of life after treatment.
Low Risk is the following:
PSA less than 10
HIGH|INTERMEDIATE
The Gleason Grading System
Screening for prostate cancer involves the prostate-specific antigen test and a digital rectal exam. If results are suspect, your doctor may recommend a prostate biopsythe only way to confirm the diagnosis.
During a prostate biopsy, a urologist uses a small needle to remove tissue samples from different parts of the prostate. These samplesalso called coresare then sent to a pathologist so they can review each one under a microscope.
The pathologist uses a pattern scale, developed by Donald Gleason, MD, PhD in 1966, to give each sample a grade from 1 to 5. Grade 1 cells are well-differentiated and look like normal tissue. Grade 5 cells, on the other hand, are “poorly differentiated” or even unrecognizable from normal tissue.
Your Gleason score is the sum of the two numbers that represent the most common types of tissue found in your biopsy. The first number in the equation is the most common grade present, the second number is the second most common grade. For example, if seven of your cores are grade 5 and five are grade 4, your Gleason score would be 5+4, or a Gleason 9.
Today, pathologists typically only flag tissue samples that are grade 3 or higher, making 6 the lowest Gleason score.
In 2014, a revised grading system for prostate cancercalled Grade Groupswas established. This system builds on the Gleason scoring system and breaks prostate cancer into five groups based on risk. This can help make it easier to understand the Gleason score scale.
Also Check: Can You Be Asleep During A Prostate Biopsy
Some Things To Consider When Choosing Among Treatments
Before deciding on treatment, here are some questions you may want to ask yourself:
- Are you the type of person who needs to do something about your cancer, even if it might result in serious side effects?
- Would you be comfortable with watchful waiting or active surveillance, even if it means you might have more anxiety and need more frequent follow-up appointments in the future?
- Do you need to know right away whether your doctor was able to get all of the cancer out ? Or are you comfortable with not knowing the results of treatment for a while if it means not having to have surgery?
- Do you prefer to go with the newest technology , which might have some advantages? Or do you prefer to go with better proven treatments that doctors might have more experience with?
- Which potential treatment side effects might be most distressing to you?
- How important for you are issues like the amount of time spent in treatment or recovery?
- If your initial treatment is not successful, what would your options be at that point?
Many men find it very stressful to have to choose between treatment options, and are very fearful they will choose the âwrongâ one. In many cases, there is no single best option, so itâs important to take your time and decide which option is right for you.