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Careful selection and close monitoring of low-risk prostate cancer patients on active surveillance minimizes the need for treatment
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This is a study from the University of Miami group active surveillance cohort. Two hundred and thirty patients were followed for a mean of 44 months. Fourteen percent have required definitive treatment. There have not been any cancer deaths. PSADT and clinical stage did not predict the need for treatment
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Soloway MS, Soloway CT, Eldefrawy A, et al. Careful selection and close monitoring of low-risk prostate cancer patients on active surveillance minimizes the need for treatment. Eur Urol 2010; 58:831-835. This is a study from the University of Miami group active surveillance cohort. Two hundred and thirty patients were followed for a mean of 44 months. Fourteen percent have required definitive treatment. There have not been any cancer deaths. PSADT and clinical stage did not predict the need for treatment.
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This is an update from the Johns Hopkins group of their 769 patient cohort of low-risk patients on active surveillance. There has been prospective follow-up for a median of 2.7 years (0.01-15) with 6 monthly PSA and annual repeat biopsies. Progression was classified by biopsy criteria alone. Eighty one, 59 and 41% of men required intervention at 2, 5 and 10 years, respectively. Overall, 33.2% required intervention. There have been no prostate cancer deaths
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Tosoian JJ, Trock BJ, Landis P, et al. Active surveillance program for prostate cancer: an update of the Johns Hopkins experience. JCO 2011; 29:2185-2190. This is an update from the Johns Hopkins group of their 769 patient cohort of low-risk patients on active surveillance. There has been prospective follow-up for a median of 2.7 years (0.01-15) with 6 monthly PSA and annual repeat biopsies. Progression was classified by biopsy criteria alone. Eighty one, 59 and 41% of men required intervention at 2, 5 and 10 years, respectively. Overall, 33.2% required intervention. There have been no prostate cancer deaths.
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These are the results reported from the University of California, San Francisco Group of 377 men in their cohort. Active surveillance patients had 3 monthly PSA tests and repeat biopsies at UCSF every 12-24 months. They compared serial biopsies and found 34% of men had an upgrade in their Gleason score. Eighty-one percent of those upgraded had so on their second biopsy. Of those who had mapping biopsies at diagnosis and a future upgrade, 37% did so in a previously uninvolved site
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Porten SP, Whitson JM, Cowan JE, et al. Changes in prostate cancer grade on serial biopsy in men undergoing active surveillance. J Clin Onc 2011; 29:2795-2800. These are the results reported from the University of California, San Francisco Group of 377 men in their cohort. Active surveillance patients had 3 monthly PSA tests and repeat biopsies at UCSF every 12-24 months. They compared serial biopsies and found 34% of men had an upgrade in their Gleason score. Eighty-one percent of those upgraded had so on their second biopsy. Of those who had mapping biopsies at diagnosis and a future upgrade, 37% did so in a previously uninvolved site.
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These are results of a prospective active surveillance program for Toronto. They have followed 450 low-risk patients for a median of 6.8 years (1-13). Patients had a 3 monthly PSA for 2 years then 6 monthly while stable. Repeat biopsy was performed after 6-12 months and then every 3-4 years. Criteria for intervention were classified as a PSADT less than 3 years (2 years for the initial 4 years of the program), Gleason 4+3 or more or clinical progression. Their 10-year prostate cancer acturial survival is 97.2% and an overall survival 78.6%. Hazard ratio for nonprostate cancer-to-prostate cancer deaths mortality was 33.3 (95% CI 8.2-136) in 70-year olds or older and 8.76 (95% CI 2.65-28.9) in younger than 70-year-olds
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Klotz L, Zhang L, Lam A. Clinical results of long-term follow-up of a large, active surveillance cohort with localized prostate cancer. JCO 2010; 28:126-131. These are results of a prospective active surveillance program for Toronto. They have followed 450 low-risk patients for a median of 6.8 years (1-13). Patients had a 3 monthly PSA for 2 years then 6 monthly while stable. Repeat biopsy was performed after 6-12 months and then every 3-4 years. Criteria for intervention were classified as a PSADT less than 3 years (2 years for the initial 4 years of the program), Gleason 4+3 or more or clinical progression. Their 10-year prostate cancer acturial survival is 97.2% and an overall survival 78.6%. Hazard ratio for nonprostate cancer-to-prostate cancer deaths mortality was 33.3 (95% CI 8.2-136) in 70-year olds or older and 8.76 (95% CI 2.65-28.9) in younger than 70-year-olds.
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[E-pub ahead of print] Onehundred and one cohort of patients entered on to an active surveillance program with transrectal biopsies who were restaged with template prostate biopsies. Thirty-four percent were found to have more significant disease on Gleason score or tumour volume. Of the men upstaged, 44% had disease predominantly in the anterior gland
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