An Evidence Review of Active Surveillance in Men With Localized Prostate Cancer PDF Download

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Languages : en
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Author:
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Languages : en
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Book Description
BACKGROUND: Radical prostatectomy and radiation therapy for prostate cancer have side effects and unclear survival benefits for early stage and low-risk disease. Prostate cancer often has an indolent natural history, making observational management strategies potentially appealing. PURPOSE: To systematically review the role of active surveillance for triggers to begin curative treatment in men with low-risk prostate cancer. Key Questions address changes in prostate cancer characteristics over time, definitions of active surveillance and other observational strategies, factors affecting the offer of, acceptance of, and adherence to active surveillance, the comparative effectiveness of active surveillance with curative treatments, and research gaps. DATA SOURCES: MEDLINE(r), Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, and existing systematic reviews, evidence reports, and economic evaluations. STUDY SELECTION: Randomized controlled trials and nonrandomized comparative studies of treatments, multivariable association studies, and studies of temporal trends in prostate cancer natural history. Only published, peer-reviewed, English-language articles were selected based on predetermined eligibility criteria. DATA EXTRACTION: A standardized protocol was used to extract details on design, diagnoses, interventions, predictive factors, outcomes, and study validity. DATA SYNTHESIS: In total, 80 studies provided information on epidemiologic trends; 56 on definitions of active surveillance; 42 on factors affecting the offer of, acceptance of, or adherence to observational management strategies; and 26 on comparative effectiveness. Increased diagnosis of early-stage prostate cancer due to prostate-specific antigen (PSA) testing, led to an increase in prostate cancer incidence from the mid-1980s to the mid-1990s. The prostate cancer-specific mortality rate decreased for all age groups from the early-1990s to 1999. Currently, patients are diagnosed with earlier stage and lower risk prostate cancers compared to the pre-PSA era. Over time, a lower proportion of men received observational management versus active treatment, even among those with low-risk disease. There was no standardized definition of active surveillance. Sixteen cohorts used different monitoring protocols, all with different combinations of periodic digital rectal examination, PSA testing, rebiopsy, and/or imaging findings. Predictors that a patient received no initial active treatment generally included older age, presence of comorbidities, lower Gleason score, lower tumor stage, lower diagnostic PSA, and lower disease progression risk group. No trial provided results comparing men with localized disease on active surveillance with surgery or radiation therapy. LIMITATIONS: Because of the nonstandardized usages of the terms "active surveillance" and "watchful waiting" and their intended and often mixed (both curative and palliative) treatment objectives, it was difficult to determine which study patients received active monitoring for triggers indicative of curative treatment and which observation for clinical symptoms indicative of palliative treatment. CONCLUSIONS: More men are being diagnosed with early stage prostate cancer. Whether active monitoring with a curative intent is an appropriate option for these men remains unclear. A standard, universally agreed-upon definition of active surveillance that clearly distinguishes it from watchful waiting and other observational management strategies is needed to help clarify scientific discourse on this topic. Ongoing clinical trials may provide information on the comparative effectiveness of active surveillance compared to immediate active treatment, but will require long term followup.

Author: U. S. Department of Health and Human Services
Publisher: CreateSpace
ISBN: 9781484054628
Category : Medical
Languages : en
Pages : 344

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In 2011, more than 240,000 men are projected to be diagnosed with prostate cancer, and 33,000 are projected to die from the disease in the United States. In the United States, most cases of prostate cancer are detected via prostate-specific antigen (PSA) screening. The cancer is usually localized, and most tumors have low histological grades and low Gleason scores. Indeed, more than half of prostate cancers detected by PSA screening are expected to be early-stage, low-risk tumors. Such cancers are an infrequent cause of death, and those affected are more likely to die of unrelated causes. A number of immediate active treatment options are available for localized prostate cancer. Most commonly, radical prostatectomy (RP) or radiation therapy (RT), with or without androgen deprivation therapy (ADT), are offered with curative intent. However, the clinical benefit of immediate therapy with curative intent has not yet been demonstrated for localized prostate cancer in a PSA-screened population. It is likely that a large number of men are receiving active treatment with curative intent without much likelihood of obtaining any clinical benefit due to the slow progression of many prostate tumors. Both surgical and radiation treatments result in significant short- and long-term adverse events, including impotence, urinary dysfunction, and other complications. Thus, determination of the appropriate management strategy for early-stage, low-risk prostate cancer is an important public health concern. Active surveillance (AS) and watchful waiting (WW) are two observational followup strategies that forgo immediate therapy in patients with prostate cancer, with the goal of minimizing the morbidities and costs of immediate active treatment for men who may never develop cancer-related symptoms or who are interested in palliative treatments only. AS is curative in intent, and WW is palliative. AS is appropriate in men with disease believed to be indolent and therefore may not require therapy. Because prediction tools are imperfect, these men are monitored closely and treated with curative intent at signs of progression or patient choice. In this way, the considerable adverse effects of treatment are at best avoided, and at least deferred. This approach is to be distinguished from men for whom treatment is deemed inappropriate because of comorbidity; for these men, WW is generally considered, as it offers the option of palliative therapy upon symptomatic disease progression. AS often entails a multifactorial followup of patients—monitoring of PSA values, digital rectal examinations (DRE), prostate imaging, and periodic prostate biopsies—while WW is commonly a relatively passive strategy—with interventions triggered by symptoms. However, there is a continuum of aggressiveness of followup for both AS and WW, as practiced in the community. The objective of this report is to summarize the existing literature regarding the role of AS in the management of early-stage, low-risk prostate cancer. Both the report and the corresponding NIH State-of-the-Science conference are a part of the NIH Consensus Development Program, the purpose of which is to evaluate the scientific evidence on a particular topic and develop a consensus statement that advances research in that area. Key Questions provided to the EPC for systematic review include: 1. How have the patient population and the natural history of prostate cancer diagnosed in the United States changed in the last 30 years? 2. How are active surveillance and other observational management strategies defined? 3. What factors affect the offer of, acceptance, and adherence to active surveillance? 4. What are the comparative short- and long-term outcomes of active surveillance versus immediate treatment with curative intent for localized prostate cancer? 5. What are the research needs regarding active surveillance (or watchful waiting) in localized prostate cancer?

Author: Laurence Klotz
Publisher: Humana Press
ISBN: 3319627104
Category : Medical
Languages : en
Pages : 249

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This fully updated and revised new edition provides a comprehensive, state-of-the art review of this field, and will serve as a valuable resource for clinicians, surgeons and researchers with an interest in prostate cancer. The book reviews new data about molecular characteristics of the disease, profiles the new grading system for prostate cancer introduced in 2015, and provides new perspectives about imaging of prostate cancer, as well as the role of targeted biopsies. The text summarizes the role of biomarkers and MRI in patient selection and management and details the world wide results of active surveillance. Specific chapters address communication and ethical issues, QOL outcomes, economic aspects, and psycho-social aspects of surveillance. The role of focal therapy for low risk disease is summarized, and the data supporting preventive interventions during surveillance reviewed. This text will serve as a very useful resource for physicians and researchers dealing with, and interested in this common malignancy, as it provides a concise yet comprehensive summary of the current status of the field that will help guide patient management and stimulate investigative efforts.

Author: Laurence Klotz
Publisher: Springer Science & Business Media
ISBN: 1617799122
Category : Medical
Languages : en
Pages : 212

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Active Surveillance for Localized Prostate Cancer: A New Paradigm for Clinical Management will serve as a useful resource for physicians dealing with, and interested in, this complex and evolving branch of prostate cancer management. The book will also be of interest to scientifically literate patients and their families. The volume provides an introduction to the concept of active surveillance in oncology in general and prostate cancer specifically. The primary focus is to provide a comprehensive guide to the management of patients on surveillance. The volume covers the many complexities and nuances to this approach including, patient selection, risk assessment, how to overcome 'cancer hysteria' when counseling patients, identifying appropriate triggers for intervention, use of PSA kinetics and MR imaging information, technique and frequency of biopsies, secondary prevention interventions, and the relative roles of surveillance and focal therapy.

Author: Amelie G. Ramirez
Publisher: Springer Nature
ISBN: 303029286X
Category : Medical
Languages : en
Pages : 320

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This open access book gives an overview of the sessions, panel discussions, and outcomes of the Advancing the Science of Cancer in Latinos conference, held in February 2018 in San Antonio, Texas, USA, and hosted by the Mays Cancer Center and the Institute for Health Promotion Research at UT Health San Antonio. Latinos – the largest, youngest, and fastest-growing minority group in the United States – are expected to face a 142% rise in cancer cases in coming years. Although there has been substantial advancement in cancer prevention, screening, diagnosis, and treatment over the past few decades, addressing Latino cancer health disparities has not nearly kept pace with progress. The diverse and dynamic group of speakers and panelists brought together at the Advancing the Science of Cancer in Latinos conference provided in-depth insights as well as progress and actionable goals for Latino-focused basic science research, clinical best practices, community interventions, and what can be done by way of prevention, screening, diagnosis, and treatment of cancer in Latinos. These insights have been translated into the chapters included in this compendium; the chapters summarize the presentations and include current knowledge in the specific topic areas, identified gaps, and top priority areas for future cancer research in Latinos. Topics included among the chapters: Colorectal cancer disparities in Latinos: Genes vs. Environment Breast cancer risk and mortality in women of Latin American origin Differential cancer risk in Latinos: The role of diet Overcoming barriers for Latinos on cancer clinical trials Es tiempo: Engaging Latinas in cervical cancer research Emerging policies in U.S. health care Advancing the Science of Cancer in Latinos proves to be an indispensable resource offering key insights into actionable targets for basic science research, suggestions for clinical best practices and community interventions, and novel strategies and advocacy opportunities to reduce health disparities in Latino communities. It will find an engaged audience among researchers, academics, physicians and other healthcare professionals, patient advocates, students, and others with an interest in the broad field of Latino cancer.

Author: Martin D. Abeloff
Publisher:
ISBN: 9780443075452
Category : Cancer
Languages : en
Pages : 0

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A must-have reference, this new edition provides practical information on treatment guidelines, details of diagnosis and therapy, and personal recommendations on patient management from experts in the field. Consistently formatted chapters allow for a user-friendly presentation for quick access of key information by the practicing clinician. Completely updated, this new edition includes all of the latest developments in treatment strategies of medical, surgical and radiation oncologists.

Author: Nelson N. Stone
Publisher: Springer
ISBN: 3319214853
Category : Medical
Languages : en
Pages : 213

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This text provides a comprehensive, state-of-the art review of this field, and will serve as a valuable resource for clinicians, surgeons and researchers with an interest in early prostate cancer. The book reviews new data about genetic markers, transperineal mapping biopsy and mpMRI, how to apply each of these technologies in patients with elevated PSA, when a prior prostate biopsy performed by the standard TRUS method is negative and in cases where low risk disease is already diagnosed, how to differentiate those men who might harbor more aggressive disease from those who do not. Over 75% of newly diagnosed prostate cancer meets the criteria for low risk disease which has created a dilemma for both patients and clinicians. Active surveillance programs have been initiated and are reviewed. How the new technologies impact surveillance programs is addressed. Clinical stage designation is updated and a new intra-prostatic staging system is discussed. Prostate biopsy techniques utilizing transrectal ultrasound, transperineal mapping, elastography and mpMRI are compared. Finally, utilization of this new technology in the application of focal therapy is reviewed. The Prostate Cancer Dilemma will serve as a very useful resource for physicians and researchers dealing with, and interested in this challenging malignancy. Chapters are written by experts in their fields and include the most up to date scientific and clinical information as well as links to procedural video content.

Author: Andrew W. Bruce
Publisher: Springer Science & Business Media
ISBN: 1447113985
Category : Medical
Languages : en
Pages : 363

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Book Description
Carcinoma of the prostate increasingly dominates the attention of urologists for both scientific and clinical reasons. The search for an explanation and the prediction of the variable behaviour of the malignant prostatic cell continues unabated. The search for more precise tumour staging and more effective treatment is equally vigorous. Editors Andrew Bruce and John Trachtenberg have assembled acknowledged leaders in prostate cancer to present those areas of direct interest to the clinician. There are a number of other topics that might have been considered but most of these, such as experimental tumour models or biochemical factors affecting cell growth, still lack immediate application for the clinician. Carcinoma of the prostate continues to have its highest incidence in the western world, and the difference in comparison with the incidence in the Far East appears to be real and not masked by diagnostic or other factors. A number of other epidemiological aspects need careful analysis: Is the incidence increasing? Is the survival improving? Is the prognosis worse in the younger patient? Epidemiological data are easily misused and misinterpreted so that a precise analysis of the known facts makes an important opening chapter to this book.

Author: Jack Cuzick
Publisher: Springer Science & Business Media
ISBN: 3642451950
Category : Medical
Languages : en
Pages : 167

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Book Description
Prostate cancer is by far the most common cancer in men and the second leading cause of death due to cancer. It comprises a mixed group of tumours displaying varying clinical behaviour: while some have a very aggressive course, others are rather indolent. Prevention of prostate cancer and discrimination between aggressive and indolent forms are important clinical goals and the acquisition of significant new evidence on means of achieving these aims makes this book particularly timely. A wide range of topics are covered by leading authorities in the field. The biology and natural history of prostate cancer are reviewed and the role of lifestyle and dietary factors, assessed. Detailed attention is paid to risk prediction biomarkers and to the role of novel high-throughput nucleic acid-based technologies in improving risk prediction and thereby allowing tailored approaches to cancer prevention. Potential means of chemoprevention of prostate cancer are also reviewed in depth, covering the very positive new data on the impact of aspirin as well as evidence regarding 5α-reductase inhibitors, DFMO and lycopene. Guidance is provided on the differentiation of aggressive from indolent disease and the policy and research implications of recent findings are examined. This book will be of interest to both clinicians and researchers.