Active Surveillance For Low Risk Prostate Cancer

The prostate is part of the male genitourinary tract. It is a walnut-sized gland, located underneath the urinary bladder, enveloping the proximal part of the urethra. The main function of the prostate is the excretion of a fl uid that forms part of the semen, but it also has an important role in controlling the fl ow of semen at the moment of ejaculation. Cancer of the prostate is a major health issue, it is mainly found in elderly men. In the United States, as an example for most Western countries, prostate cancer (PC) is the most frequently diagnosed non-skin cancer and is the second leading cause of cancerrelated mortality in men. A total of 192.280 new cases are estimated to be detected and 27.360 men are estimated to die of this disease in 2009 in the United States1. This means that 1 out of every 6 men will be diagnosed with the disease during their lifetime and 1 out of every 35 will die of it. The impressively high frequency of PC is further illustrated by autopsy studies, which show that as much as 55% of men in their fi fties and 64% of men in their seventies harbour the disease

Rule-based versus probabilistic selection for active surveillance using three definitions of insignificant prostate cancer

To study whether probabilistic selection by the use of a nomogram could improve patient selection for active surveillance (AS) compared to the various sets of rule-based AS inclusion criteria currently used. We studied Dutch and Swedish patients participating in the European Randomized study of Screening for Prostate Cancer (ERSPC). We explored which men who were initially diagnosed with cT1-2, Gleason 6 (Gleason pattern a parts per thousand currency sign3 + 3) had histopathological indolent PCa at RP [defined as pT2, Gleason pattern a parts per thousand currency sign3 and tumour volume (TV) a parts per thousand currency sign0.5 or TV a parts per thousand currency sign 1.3 ml, and TV no part of criteria (NoTV)]. Rule-based selection was according to the Prostate cancer Research International: Active Surveillance (PRIAS), Klotz, and Johns Hopkins criteria. An existing nomogram to define probability-based selection for AS was refitted for the TV1.3 and NoTV indolent PCa definitions. 619 of 864 men undergoing RP had cT1-2, Gleason 6 disease at diagnosis and were analysed. Median follow-up was 8.9 years. 229 (37 %), 356 (58 %), and 410 (66 %) fulfilled the TV0.5, TV1.3, and NoTV indolent PCa criteria at RP. Discriminating between indolent and significant disease according to area under the curve (AUC) was: TV0.5: 0.658 (PRIAS), 0.523 (Klotz), 0.642 (Hopkins), 0.685 (nomogram). TV1.3: 0.630 (PRIAS), 0.550 (Klotz), 0.615 (Hopkins), 0.646 (nomogram). NoTV: 0.603 (PRIAS), 0.530 (Klotz), 0.589 (Hopkins), 0.608 (nomogram). The performance of a nomogram, the Johns Hopkins, and PRIAS rule-based criteria are comparable. Because the nomogram allows individual trade-offs, it could be a good alternative to rigid rule-based criteria

A longitudinal study on the impact of active surveillance for prostate cancer on anxiety and distress levels

Objective: Patients with potentially indolent prostate cancer (PC) can be managed with active surveillance (AS). Our objective was to analyse how anxiety and distress develop in men with untreated PC and whether highly anxious men quit AS. Methods: One hundred and fifty Dutch patients who opted for AS in the Prostate cancer Research International: Active Surveillance Study were invited to participate in an additional prospective, longitudinal quality of life (QoL) study within 6months after diagnosis. Participants completed questionnaires with validated measures on anxiety and distress at inclusion (t=0), 9 (t=9) and 18 (t=18) months after diagnosis. We assessed changes in scores on depression (Center for Epidemiologic Studies Depression (CES-D) scale), generic anxiety (State-Trait Anxiety Inventory (STAI-6)), PC-specific anxiety (Memorial Anxiety Scale for Prostate Cancer (MAX-PC)) and decisional conflict (Decisional Conflict Scale (DCS)) about patients' treatment choice between t=0, t=9 and t=18 using repeated measures analysis. Results: Response rates for patients still on AS at t=0, t=9 and t=18 assessments were 86%, 90% and 96%, respectively. Nine patients (7%, 9/129) between t=0 and t=9 and 33 of 108 patients (31%) between t=9 and t=18 stopped AS, mostly (86%) because of protocol-based reasons. CES-D, total MAX-PC and DCS scores did not change significantly (p>0.05) when comparing t=18 with t=9 and t=0 scores, but generic anxiety (STAI-6; p=0.033