Journal of Reconstructive Urology

.: ORIGINAL RESEARCH
The Active Surveillance for Low-risk Prostate Cancer: Case Series of Single Center
Düşük Riskli Prostat Kanserleri İçin Aktif İzlem: Tek Merkezin Olgu Serisi
İlker AKARKENa, Harun BALa, Hüseyin TARHANa, Hasan DELİKTAŞa, Hayrettin ŞAHİNa
aDepartment of Urology, Muğla Sıtkı Koçman University Faculty of Medicine, Muğla, TURKEY
J Reconstr Urol. 2021;11(2):73-8
doi: 10.5336/urology.2021-81636
Article Language: EN
Full Text
ABSTRACT
 Objective: Up to 80% of prostate cancer cases are indolent that pose a minimal risk for morbidity and mortality throughout the life of the patient. Cancer-specific survival of the patients just followed up and those who received curative treatment were found to be similar, especially in the low-risk category. Active surveillance was described to preserve the quality of life of the patients and to protect them from the side effects of curative treatments. It has become increasingly used in low and very low risk. Although there are many studies on this subject with a large number of patients in the literature, we aimed to present our first results in this study. Material and Methods: The data of the patients, that were included in the active surveillance program between January 2012 and April 2020, were retrospectively analyzed. The patients were diagnosed with low-risk prostate cancer according to D'Amico criteria (International Society of Urological Pathology grade group 1, prostate-specific antigen <10 ng/mL, stage cT1c-T2a) via a minimum 12 core transrectal ultrasound guided prostate biopsy due to suspicious digital rectal examination and/or prostate-specific antigen elevation. Results: Thirty-six patients, who preferred active surveillance were included in the study. The mean age and prostate-specific antigen values of the patients were 66.38±8.02 years and 5.63±2.3 ng/mL, respectively. The median follow- up was 18.4 (minimum 1.63-maximum 82.4) months. In the initial biopsy, the cancer was detected in one core in 25 (69.4%), two cores in 10 (27.8%), and three cores in one (2.8%) of the patients. A total of 7 (19.4%) cases had received curative treatment. 3 cases had progression in pathological parameters and 4 cases chose to have active treatment. Conclusion: Our initial results with active surveillance are similar to the literature. Per the literature, the number of patients that chose active surveillance has increased.

Keywords: Prostate biopsy; cancer; surveillance
ÖZET
 Prostat kanseri vakalarının %80 kadarı indolenttir. Hastanın yaşamı boyunca morbidite ve mortalite için minimum risk oluştururlar. Sadece takip edilenler ile küratif tedavi alan hastaların kansere özgü sağ kalımları, özellikle düşük risk kategorisinde benzer bulunmuştur. Aktif izlem, hastaların yaşam kalitesini korumanın yanı sıra onları küratif tedavilerin yan etkilerinden korumak için tanımlandı. Aktif izlem, düşük ve çok düşük riskte giderek daha fazla kullanılmaktadır. Literatürde, bu konuda çok sayıda hasta ile birçok çalışma olsa da çalışmamızda ilk sonuçlarımızı sunmayı amaçladık. Gereç ve Yöntemler: Ocak 2012 ile Nisan 2020 tarihleri arasında aktif izlem programına alınan hastaların verileri retrospektif olarak değerlendirildi. Hastalara, şüpheli dijital rektal muayene ve/veya prostat-spesifik antijen seviyesinin yükselmesi nedeniyle minimum 12 kor transrektal ultrason kılavuzluğunda prostat biyopsisi yapılmış olup, D'Amico kriterlerine göre düşük riskli prostat kanseri (International Society of Urological Pathology grade group 1, prostat-spesifik antijen <10 ng/mL, evre cT1c-T2a) teşhisi konulmuştur. Bulgular: Çalışmaya, aktif izlemi tercih eden 36 hasta dâhil edildi. Hastaların ortalama yaş ve prostat spesifik antijen değerleri sırasıyla 66,38±8,02 yıl ve 5,63±2,3 ng/mL idi. Ortanca takip süresi 18,4 (minimum 1,63-maksimum 82,4) aydı. İlk biyopside hastaların 25'inde (%69,4) 1, 10'unda (%27,8) 2 ve 1'inde (%2,8) 3 odakta kanser tespit edilmişti. Toplam 7 (%19,4) vaka, küratif tedavi almıştı. Üç vaka, patolojik parametrelerde ilerleme gösterdi ve 4 vaka, aktif tedavi olmayı seçti. Sonuç: Aktif izlemde ilk sonuçlarımız, literatür ile benzerdir ve kliniğimizde, aktif izlemi tercih eden hasta sayısı artmaktadır.

Anahtar Kelimeler: Prostat biyopsisi; kanser; izlem
REFERENCES:
  1. Siegel RL, Miller KD, Jemal A. Cancer statistics, 2020. CA Cancer J Clin. 2020;70(1):7-30. [Crossref]  [PubMed] 
  2. Bray F, Ferlay J, Soerjomataram I, Siegel RL, Torre LA, Jemal A. Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin. 2018;68(6):394-424. Erratum in: CA Cancer J Clin. 2020;70(4): 313. [Crossref]  [PubMed] 
  3. Albertsen PC, Hanley JA, Fine J. 20-year outcomes following conservative management of clinically localized prostate cancer. JAMA. 2005;293(17):2095-101. [Crossref]  [PubMed] 
  4. Cooperberg MR, Broering JM, Carroll PR. Time trends and local variation in primary treatment of localized prostate cancer. J Clin Oncol. 2010;28(7):1117-23. [Crossref]  [PubMed]  [PMC] 
  5. Wei JT, Dunn RL, Sandler HM, McLa ughlin PW, Montie JE, Litwin MS, et al. Comprehensive comparison of health-related quality of life after contemporary therapies for localized prostate cancer. J Clin Oncol. 2002;20(2):557-66. [Crossref]  [PubMed] 
  6. Vickers A, Bennette C, Steineck G, Adami HO, Johansson JE, Bill-Axelson A, et al. Individualized estimation of the benefit of radical prostatectomy from the Scandinavian Prostate Cancer Group randomized trial. Eur Urol. 2012;62(2):204-9. [Crossref]  [PubMed]  [PMC] 
  7. Bill-Axelson A, Holmberg L, Garmo H, Rider JR, Taari K, Busch C, et al. Radical prostatectomy or watchful waiting in early prostate cancer. N Engl J Med. 2014;370(10):932-42. [Crossref]  [PubMed]  [PMC] 
  8. Choo R, Klotz L, Danjoux C, Morton GC, DeBoer G, Szumacher E, et al. 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. [Crossref]  [PubMed] 
  9. Loeb S, Folkvaljon Y, Curnyn C, Robinson D, Bratt O, Stattin P. Uptake of active surveillance for very-low-risk prostate cancer in Sweden. JAMA Oncol. 2017;3(10):1393-8. [Crossref]  [PubMed]  [PMC] 
  10. National Comprehensive Cancer Network [Internet]. Copyright © 2021 National Comprehensive Cancer Network [Cited 14 April 2020]. NCCN Guidelines: Prostate Cancer (Version 1.2020). Available from: [Link] 
  11. European Association of Urology [Internet]. © Copyright 2021 Uroweb [Cited 15 April 2020]. EAU Guidelines: Prostate Cancer | Uroweb. Available from: [Link] 
  12. D'Amico AV, Whittington R, Malkowicz SB, Schultz D, Blank K, Broderick GA, et al. Biochemical outcome after radical prostatectomy, external beam radiation therapy, or interstitial radiation therapy for clinically localized prostate cancer. JAMA. 1998;280(11):969-74. [Crossref]  [PubMed] 
  13. Schröder FH, Hugosson J, Roobol MJ, Tammela TL, Zappa M, Nelen V, et al; ERSPC Investigators. Screening and prostate cancer mortality: results of the European Randomised Study of Screening for Prostate Cancer (ERSPC) at 13 years of follow-up. Lancet. 2014;384(9959):2027-35. [Crossref]  [PubMed]  [PMC] 
  14. Welch HG, Black WC. Overdiagnosis in cancer. J Natl Cancer Inst. 2010;102(9):605-13. [Crossref]  [PubMed] 
  15. Wilt TJ, Brawer MK, Jones KM, Barry MJ, Aronson WJ, Fox S, et al; Prostate Cancer Intervention versus Observation Trial (PIVOT) Study Group. Radical prostatectomy versus observation for localized prostate cancer. N Engl J Med. 2012;367(3):203-13. Erratum in: N Engl J Med. 2012;367(6):582. [Crossref]  [PubMed]  [PMC] 
  16. Whiting PF, Moore TH, Jameson CM, Davies P, Rowlands MA, Burke M, et al. Symptomatic and quality-of-life outcomes after treatment for clinically localised prostate cancer: a systematic review. BJU Int. 2016;118(2):193-204. [Crossref]  [PubMed] 
  17. Donovan JL, Hamdy FC, Lane JA, Mason M, Metcalfe C, Walsh E, et al; ProtecT Study Group*. Patient-reported outcomes after monitoring, surgery, or radiotherapy for prostate cancer. N Engl J Med. 2016;375(15):1425-37. [PubMed]  [PMC] 
  18. Leapman MS, Cowan JE, Nguyen HG, Shinohara KK, Perez N, Cooperberg MR, et al. Active surveillance in younger men with prostate cancer. J Clin Oncol. 2017;35(17): 1898-904. [Crossref]  [PubMed]  [PMC] 
  19. Klotz L, Vesprini D, Sethukavalan P, Jethava V, Zhang L, Jain S, et al. Long-term follow-up of a large active surveillance cohort of patients with prostate cancer. J Clin Oncol. 2015;33(3): 272-7. [Crossref]  [PubMed] 
  20. Reese AC, Landis P, Han M, Epstein JI, Carter HB. Expanded criteria to identify men eligible for active surveillance of low risk prostate cancer at Johns Hopkins: a preliminary analysis. J Urol. 2013;190(6):2033-8. [Crossref]  [PubMed] 
  21. Soloway MS, Soloway CT, Eldefrawy A, Acosta K, Kava B, Manoharan M. Careful selection and close monitoring of low-risk prostate cancer patients on active surveillance minimizes the need for treatment. Eur Urol. 2010;58(6):831-5. [Crossref]  [PubMed] 
  22. Musunuru HB, Yamamoto T, Klotz L, Ghanem G, Mamedov A, Sethukavalan P, et al. Active surveillance for intermediate risk prostate cancer: survival outcomes in the Sunnybrook experience. J Urol. 2016;196(6):1651-8. [Crossref]  [PubMed] 
  23. van der Poel HG, van den Bergh RC. Difference of opinion - Active surveillance in intermediate risk prostate cancer: is it safe? Opinion: Yes. Int Braz J Urol. 2016;42(3):413-7. [Crossref]  [PubMed]  [PMC] 
  24. Macleod LC, Ellis WJ, Newcomb LF, Zheng Y, Brooks JD, Carroll PR, et al. Timing of adverse prostate cancer reclassification on first surveillance biopsy: results from the canary prostate cancer active surveillance study. J Urol. 2017;197(4):1026-33. [Crossref]  [PubMed]  [PMC] 
  25. Mamawala MM, Rao K, Landis P, Epstein JI, Trock BJ, Tosoian JJ, et al. Risk prediction tool for grade re-classification in men with favourable-risk prostate cancer on active surveillance. BJU Int. 2017;120(1):25-31. [Crossref]  [PubMed] 
  26. Davis JW, Ward JF 3rd, Pettaway CA, Wang X, Kuban D, Frank SJ, et al. Disease reclassification risk with stringent criteria and frequent monitoring in men with favourable-risk prostate cancer undergoing active surveillance. BJU Int. 2016;118(1):68-76. [Crossref]  [PubMed]  [PMC] 
  27. Druskin SC, Mamawala M, Tosoian JJ, Epstein JI, Pavlovich CP, Carter HB, et al. Older age predicts biopsy and radical prostatectomy grade reclassification to aggressive prostate cancer in men on active surveillance. J Urol. 2019;201(1):98-104. [Crossref]  [PubMed] 
  28. Filson CP, Natarajan S, Margolis DJ, Huang J, Lieu P, Dorey FJ, et al. Prostate cancer detection with magnetic resonance-ultrasound fusion biopsy: The role of systematic and targeted biopsies. Cancer. 2016;122(6):884-92. [Crossref]  [PubMed]  [PMC] 
  29. Siddiqui MM, Rais-Bahrami S, Truong H, Stamatakis L, Vourganti S, Nix J, et al. Magnetic resonance imaging/ultrasound-fusion biopsy significantly upgrades prostate cancer versus systematic 12-core transrectal ultrasound biopsy. Eur Urol. 2013;64(5):713-9. [Crossref]  [PubMed]  [PMC] 
  30. Da Rosa MR, Milot L, Sugar L, Vesprini D, Chung H, Loblaw A, et al. A prospective comparison of MRI-US fused targeted biopsy versus systematic ultrasound-guided biopsy for detecting clinically significant prostate cancer in patients on active surveillance. J Magn Reson Imaging. 2015;41(1):220-5. [Crossref]  [PubMed] 
  31. Schulman AA, Sze C, Tsivian E, Gupta RT, Moul JW, Polascik TJ. The contemporary role of multiparametric magnetic resonance imaging in active surveillance for prostate cancer. Curr Urol Rep. 2017;18(7):52. [Crossref]  [PubMed] 
  32. Womble PR, Montie JE, Ye Z, Linsell SM, Lane BR, Miller DC; Michigan Urological Surgery Improvement Collaborative. Contemporary use of initial active surveillance among men in Michigan with low-risk prostate cancer. Eur Urol. 2015;67(1):44-50. [Crossref]  [PubMed] 
  33. Van Hemelrijck M, Ji X, Helleman J, Roobol MJ, van der Linden W, Nieboer D, et al; Members of the Movember Foundation's Global Action Plan Prostate Cancer Active Surveillance GAP3 consortium; Members of the Movember Foundation's Global Action Plan Prostate Cancer Active Surveillance GAP3 consortium. Reasons for discontinuing active surveillance: assessment of 21 centres in 12 countries in the movember GAP3 consortium. Eur Urol. 2019;75(3):523-31. [PubMed] 
  34. Soydan H, Dursun F, Yılmaz Ö, Okçelik S, Ateş F, Karademir K. Our results of active surveillance for localized prostate cancer patients. Turk J Urol. 2013;39(1):1-5. [Crossref]  [PubMed]  [PMC] 
  35. Bayar G, Horasanlı K, Acinikli H, Tanrıverdi O, Dalkılıç A, Arısan S. The importance of active surveillance, and immediate re-biopsy in low-risk prostate cancer: The largest series from Turkey. Turk J Urol. 2016;42(3):140-4. [Crossref]  [PubMed]  [PMC] 

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