Dataset Information

The long-term outcomes of Gleason grade groups 2 and 3 prostate cancer managed by active surveillance: Results from a large, population-based cohort.

ABSTRACT: INTRODUCTION:Active surveillance (AS) is an accepted management strategy for low-risk prostate cancer (PCa), but its role in the management of favorable intermediate-risk PCa remains controversial. Most reports studying the role of AS for these men generally lack long-term followup and include small numbers of patients. Our objective was to report the outcomes of men diagnosed with Gleason grade groups (GGG) 2 and 3 PCa who were managed expectantly. METHODS:Using administrative datasets and pathology reports, we identified all men who were diagnosed with GGG 2 and 3 PCa and managed expectantly between 2002 and 2011 in Ontario, Canada. Outcomes and associated factors were estimated using cumulative incidence function methods and multivariable Cox regression models, respectively. RESULTS:We identified 926 men who were managed expectantly (AS [n=374] or watchful waiting [n=552]). The eight-year cancer-specific survival was 94% and 89% for the AS and watchful waiting cohorts, respectively. Among AS men, 266 (71%) received treatment after a followup of approximately eight years. Cumulative AS discontinuation rates at one and five years were 30.5% and 65.1%, respectively. CONCLUSIONS:Expectant management of GGG 2 and 3 PCa may be an option for certain men. Notably for AS patients, the cancer-specific mortality at eight years was 6%, and over 65% of men underwent treatment within five years. Further studies are required to evaluate which patients, based on disease-specific features and competing health risks, would benefit most from a conservative strategy.

SUBMITTER: Richard PO

PROVIDER: S-EPMC7654679 | biostudies-literature | 2020 Jun

REPOSITORIES: biostudies-literature

ACCESS DATA

Publications

The long-term outcomes of Gleason grade groups 2 and 3 prostate cancer managed by active surveillance: Results from a large, population-based cohort.

Richard Patrick O PO Timilshina Narhari N Komisarenko Maria M Martin Lisa L Ahmad Ardalan A Alibhai Shabbir M H SMH Hamilton Robert J RJ Kulkarni Girish S GS Finelli Antonio A

Canadian Urological Association journal = Journal de l'Association des urologues du Canada 20200601 6

<h4>Introduction</h4>Active surveillance (AS) is an accepted management strategy for low-risk prostate cancer (PCa), but its role in the management of favorable intermediate-risk PCa remains controversial. Most reports studying the role of AS for these men generally lack long-term followup and include small numbers of patients. Our objective was to report the outcomes of men diagnosed with Gleason grade groups (GGG) 2 and 3 PCa who were managed expectantly.<h4>Methods</h4>Using administrative da ...[more]

PMID: 31977306

Similar Datasets

Project description:BackgroundActive surveillance (AS) is a preferred management option for men with prostate cancer with favourable prognosis. However, nearly half of men on AS switch to treatment within 5 years, so therapeutic strategies to prevent or delay disease progression could be considered. The androgen receptor is the pre-eminent oncogenic driver in prostate cancer.ObjectiveTo explore image-based tumour responses and the patient impact of short-duration androgen-targeted therapy (ATT) to abrogate disease progression during AS.Design setting and participantsMen on AS with Cambridge Prognostic Group 1 & 2 (low and favourable intermediate risk) prostate cancer and lesions visible on magnetic resonance imaging (MRI) were recruited to an open-label, single-centre, phase 2 feasibility study of short-term ATT (the TAPS01 study).InterventionApalutamide 240 mg was administered for 90 days.Outcome measurements and statistical analysisMRI-measured tumour volume (TV), gland volume (GV), and the TV/GV ratio were calculated at baseline, at day 90 (end of treatment), and at 6- and 18-month follow-up. Quality of life metrics were measured at day 0, day 90, and 6 weeks after ATT.Results and limitationsEleven patients (40% of eligible men approached) agreed to participate, of whom nine completed treatment. At day 90, the median percentage reduction was -38.2% (range -51.8% to -23.5%) for GV, -54.2% (range -74.1% to -13.8%) for TV, and -27.2% (range -61.5% to -7.5%) for TV/GV (all p < 0.0001). At 6 mo, while GV had returned to baseline (p = 0.95) both TV (-31.9%; p = 0.0007) and TV/GV (-28.7%; p = 0.0009) remained significantly reduced. This reduction was sustained at 18 months (TV -18%, TV/GV -23.8%; p = 0.01). European Organization for Research and Treatment of Cancer QoL core 30-item questionnaire scores for global, physical, role, and social functioning decreased during treatment, but all were recovering by 6 weeks. EQ-VAS scores were unchanged compared to baseline.ConclusionsTAPS01 has demonstrated feasibility and patient tolerability for short-term ATT in men on AS. Our data suggest a selective and durable antitumour effect in the short term and support a larger-scale randomised trial.Patient summaryWe investigated the feasibility of short-term treatment with an androgen inhibitor to prevent or delay disease progression for men on active surveillance for prostate cancer. Results for a small group of patients show that 90-day treatment led to a sustained decrease in tumour volume over 18 months. The findings warrant a larger clinical trial for this approach, which could allow patients to delay or even avoid longer-term active treatments.

Project description:To determine the role that magnetic resonance (MR) imaging and MR spectroscopic imaging findings obtained at the time of diagnosis play in the progression of disease in patients whose prostate cancer is being managed with active surveillance and to compare the role of these findings with the role of transrectal ultrasonography (US) findings.The institutional review board approved this HIPAA-compliant retrospective study, and informed consent was obtained from all patients whose records were to be entered into the research database. All patients who had prostate cancer managed with active surveillance and who had undergone both MR imaging and MR spectroscopic imaging of the prostate and transrectal US at time of diagnosis were identified. Two urologists blinded to the clinical outcome in these patients independently reviewed and dichotomized the MR imaging report and the MR spectroscopic imaging report as normal or suggestive of malignancy. One experienced urologist performed all US examinations that were then dichotomized similarly. Uni- and multivariate (with use of standard clinical variables) Cox models were fitted to assess time to cancer progression, defined as Gleason score upgrading, prostate-specific antigen velocity of more than 0.75 (microg x L(-1))/y, or initiation of treatment more than 6 months after diagnosis.The final cohort included 114 patients with a median follow-up of 59 months. Patients with a lesion that was suggestive of cancer at MR imaging had a greater risk of the Gleason score being upgraded at subsequent biopsy (hazard ratio, 4.0; 95% confidence interval: 1.1, 14.9) than did patients without such a lesion. Neither MR spectroscopic imaging nor transrectal US could be used to predict cancer progression.Abnormal prostate MR imaging results suggestive of cancer may confer an increased risk of Gleason score upgrade at subsequent biopsy. Although expensive, prostate MR imaging may help in counseling potential candidates about active surveillance.

Dataset Information

The long-term outcomes of Gleason grade groups 2 and 3 prostate cancer managed by active surveillance: Results from a large, population-based cohort.

Publications

The long-term outcomes of Gleason grade groups 2 and 3 prostate cancer managed by active surveillance: Results from a large, population-based cohort.

Similar Datasets

OmicsDI is part of the ELIXIR infrastructure

Tweets