Search

INTRODUCTION AND OBJECTIVE:Prostate cancer (PC) provides an opportunity for secondary chemoprevention in men diagnosed with National Comprehensive Cancer Network very low, low, or favorable interme...

INTRODUCTION AND OBJECTIVE:Spatial orientation of the robotic operating room (OR) has led to isolation of the surgeon from the bedside assistants, which may impair communication and lead to surgica...

INTRODUCTION AND OBJECTIVE:Metastatic risk for small renal mass (SRM) patients on active surveillance (AS) is low and often outweighed by treatment morbidity. Rates of treatment conversion in unsel...

INTRODUCTION AND OBJECTIVES:Men with advanced prostate cancer (CaP) receive androgen deprivation therapy (ADT), which lowers circulating testosterone (T) levels, impairs androgen receptor (AR) acti...

Active surveillance is a first line treatment option for patients with low risk prostate cancer but standardized regimens are lacking, including uniform protocols for surveillance prostate biopsy. We compared the outcomes of 2 active surveillance regimens that differ in whether a scheduled biopsy was performed in the absence of clinical progression.We retrospectively reviewed the records of 313 consecutive patients with prostate cancer at a NCCN® (National Comprehensive Cancer Network®) institution who were assigned prospectively to 1 of 2 active surveillance biopsy regimens. A total of 149 patients underwent biopsy only for clinical concern (for-cause only) while 164 underwent for-cause biopsy plus scheduled annual or biannual biopsy. Times to biopsy, clinical progression, pathological reclassification and treatment were compared using Kaplan-Meier methodology.The for-cause only and scheduled plus for-cause biopsy groups were similar in NCCN risk category at active surveillance initiation. Median followup was 48 and 38 months, respectively. No significant difference was observed in prostate specific antigen dynamics or clinical progression rates. However, patients in the scheduled plus for-cause group underwent significantly more frequent biopsies (p0.001) and experienced more biopsy related complications (p = 0.04), pathological reclassification (p = 0.02) and treatment conversion (p = 0.001). Adverse prostatectomy pathology (pT3 or greater and/or Gleason primary pattern 4) and early metastasis events were rare in both groups.Omitting a scheduled biopsy during active surveillance is associated with a decreased biopsy burden and treatment conversion. Although no increase in adverse pathology or early metastasis was observed in this study, longer followup in larger cohorts is necessary to determine the impact of scheduled biopsy omission on these adverse outcomes.

We determined whether the pattern of low detectable prostate specific antigen during the first 3 years of followup after radical prostatectomy would predict subsequent biochemical recurrence.An institutional database was queried to identify 1,136 patients who underwent open retropubic or robot-assisted radical prostatectomy between January 5, 1993 and December 29, 2008. After applying exclusion criteria we used serum prostate specific antigen and the prostate specific antigen pattern during the first 3 years of followup to divide 566 men into 3 groups, including 1) undetectable prostate specific antigen (0.03 ng/ml or less), 2) low detectable-stable prostate specific antigen (greater than 0.03 and less than 0.2 ng/ml, no 2 subsequent increases and/or prostate specific antigen velocity less than 0.05 ng per year) and 3) low detectable-unstable prostate specific antigen (greater than 0.03 and less than 0.2 ng/ml, 2 subsequent increases according to NCCN criteria and/or prostate specific antigen velocity 0.05 ng per year or greater). The primary end point was biochemical recurrence, defined as prostate specific antigen 0.2 ng/ml or greater, or receipt of radiation therapy beyond 3 years of followup.Seven-year biochemical recurrence-free survival was 95%, 94% and 37% in the undetectable, low detectable-stable and low detectable-unstable groups, respectively (log rank test p0.0001). On multivariate analysis the prostate specific antigen pattern during 3 years postoperatively (undetectable vs low detectable-unstable HR 15.9 and vs low detectable-stable HR 1.6), pathological T stage (pT2 vs greater than pT2 HR 1.8), pathological Gleason score (less than 7 vs 7 HR 2.3 and less than 7 vs 8-10 HR 3.3) and surgical margins (negative vs positive HR 1.8) significantly predicted biochemical recurrence.The combination of prostate specific antigen velocity and NCCN criteria for biochemical recurrence separated well men with low detectable prostate specific antigen after radical prostatectomy into those who required treatment and those who could be safely watched.