scholarly journals Active surveillance in patients with a PSA >10 ng/mL

2014 ◽  
Vol 8 (9-10) ◽  
pp. 702 ◽  
Author(s):  
Paul Toren ◽  
Lih-Ming Wong ◽  
Narhari Timilshina ◽  
Shabbir Alibhai ◽  
John Trachtenberg ◽  
...  
Keyword(s):  
Active Surveillance ◽  
Specific Antigen ◽  
Sufficient Evidence ◽  
Hazard Ratios ◽  
Diagnostic Biopsy ◽  
Selection Of Patients ◽  
Baseline Psa ◽  
Selection Of

Introduction: The use of prostate-specific antigen (PSA) in active surveillance (AS) for prostate cancer is controversial. Some consider it an unreliable marker and others as sufficient evidence to exclude patients from AS. We analyzed our cohort of AS patients with a PSA over 10 ng/mL.Methods: We included patients who had clinical T1c–T2a Gleason ≤6 disease, and ≤3 positive cores with ≤50% core involvement at diagnostic biopsy and ≥2 total biopsies. Patients were divided into 3 groups: (1) those with baseline PSA >10 ng/mL, (2) those with a PSA rise >10 ng/mL during follow-up; and (3) those with a PSA <10 ng/mL throughout AS. Adverse histology was defined as biopsy parameters exceeding the entry criteria limits. We further compared this cohort to a concurrent institutional cohort with equal biopsy parameters treated with immediate radical prostatectomy.Results: Our cohort included 698 patients with a median follow-up of 46.2 months. In total, 82 patients had a baseline PSA >10 ng/mL and 157 had a PSA rise >10 ng/mL during surveillance. No difference in adverse histology incidence was detected between groups (p = 0.3). Patients with a PSA greater than 10 were older and had higher prostate volumes. Hazard ratios for groups with a PSA >10 were protective against adverse histology. Larger prostate volume and minimal core involvement appear as factors related to this successful selection of patients to be treated with AS.Conclusion: These results suggest that a strict cut-off PSA value for all AS patients is unwarranted and may result in overtreatment. Though lacking long-term data and validation, AS appears safe in select patients with a PSA >10 ng/mL and low volume Gleason 6 disease.

Clinical Results of Long-Term Follow-Up of a Large, Active Surveillance Cohort With Localized Prostate Cancer

2021 ◽  
pp. 25-30
Author(s):  
Niranjan Sathianathen
Keyword(s):  
Prostate Cancer ◽  
Active Surveillance ◽  
Local Treatment ◽  
Specific Antigen ◽  
Clinical Results ◽  
Curative Intent ◽  
Risk Prostate Cancer ◽  
Long Term Follow Up

This chapter provides a summary of an important observational study of men with clinically localized, mostly favorable-risk prostate cancer who were followed with active surveillance, which consisted of periodic prostate-specific antigen testing and repeat biopsies. It found that local treatment with curative intent can be safely deferred long term in many patients as long as they are carefully monitored.

Empowering a database with national long-term data about mortality: the use of national death registries

2008 ◽  
Vol 18 (S2) ◽  
pp. 188-195 ◽  
Author(s):  
David L.S. Morales ◽  
Andrew J. McClellan ◽  
Jeffrey P. Jacobs
Keyword(s):  
Pay For Performance ◽  
Personal Health Information ◽  
Standards Of Care ◽  
Long Term Follow Up ◽  
Regulatory Bodies ◽  
National Databases ◽  
Selection Of Patients ◽  
Selection Of

AbstractThe interest of professional medical societies in research about outcomes, mixed with the recent accessibility to management of data on the internet, has moved many societies to create national databases or registries for their specialty. In societies with procedure-based specialties such as surgery, these databases will help with the care of patients by predicting prognosis, defining risk-factors, and aiding with the selection of patients who are the best candidates for these procedures. These databases eventually will also help to establish standards of care. The latter is rapidly growing in importance as governments attempt to create “pay-for-performance” programs in many of the surgical specialties. It is essential to create a database from which a specialty can provide accurate data and standards to its members, its patients, and third parties, such as regulatory bodies and agencies of re-numeration. Unfortunately, surgeons often only care for their patients in the short-term peri-operative period, typically lasting weeks to months; and therefore, the ability of surgeons to create databases with long-term follow-up has been limited. The introduction of “personal health information” into a surgical database, with the intention of linking with other societies or national databases that have long-term follow-up, can remedy this weakness. This article describes the investigation by one surgical society into the available national registries of death and examines their accuracy, accessibility, cost, and their suitability in respect to the goals of that society. The information gathered, the comparisons outlined, and the processes used to determine the best combination of indices of death for this society should be translatable and hopefully useful for other societies and registries who wish to empower their databases with long-term national data about mortality.

Urinary artificial sphincter

1995 ◽  
Vol 62 (3) ◽  
pp. 356-361
Author(s):  
R. Carone ◽  
E. Vestita
Keyword(s):  
Artificial Urinary Sphincter ◽  
Urinary Continence ◽  
Artificial Sphincter ◽  
Inflatable Cuff ◽  
Urinary Sphincter ◽  
Long Term Follow Up ◽  
Selection Of Patients ◽  
Selection Of

The artificial sphincter is a well-accepted and successful method for restoring urinary continence in selected patients. The patient who will benefit from this device is one who has a poorly or non-functioning urethral sphincter mechanism. The site of inflatable cuff placement is around the bulbous urethral or bladder neck (children, women). The complications currently associated with artificial urinary sphincter are cuff erosion, infection, mechanical malfunction, recurrent or persistent incontinence, retention, hematoma. In order to get the best from the device and to justify the mechanical and infective risks, the accurate selection of patients and the identification of high risk categories is most important. It is essential that ali patients should have regular long-term follow-up after surgery.

Selection of patients who would not require long-term prostate-specific antigen monitoring after low-dose-rate brachytherapy

Brachytherapy ◽  
2018 ◽  
Vol 17 (6) ◽  
pp. 899-905 ◽  
Author(s):  
Naoya Niwa ◽  
Kazuhiro Matsumoto ◽  
Toru Nishiyama ◽  
Yasuto Yagi ◽  
Choichiro Ozu ◽  
...  
Keyword(s):  
Dose Rate ◽  
Prostate Specific Antigen ◽  
Low Dose ◽  
Specific Antigen ◽  
Low Dose Rate ◽  
Selection Of Patients ◽  
Selection Of ◽  
Low Dose Rate Brachytherapy

scholarly journals Guy’s and St Thomas NHS Foundation active surveillance prostate cancer cohort: a characterisation of a prostate cancer active surveillance database

BMC Cancer ◽  
2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Salonee Shah ◽  
Kerri Beckmann ◽  
Mieke Van Hemelrijck ◽  
Ben Challacombe ◽  
Rick Popert ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Active Surveillance ◽  
Specific Antigen ◽  
Future Research ◽  
Low Grade ◽  
Intermediate Risk ◽  
Psa Testing ◽  
Diagnostic Characteristics ◽  
Diagnostic Biopsy

Abstract Background The routine clinical use of serum prostatic specific antigen (PSA) testing has allowed earlier detection of low-grade prostate cancer (PCa) with more favourable characteristics, leading to increased acceptance of management by active surveillance (AS). AS aims to avoid over treatment in men with low and intermediate-risk PCa and multiple governing bodies have described several AS protocols. This study provides a descriptive profile of the Guy’s and St Thomas NHS Foundation Trust (GSTT) AS cohort as a platform for future research in AS pathways in PCa. Methods Demographic and baseline characteristics were retrospectively collected in a database for patients at the GSTT AS clinic with prospective collection of follow-up data from 2012. Seven hundred eighty-eight men being monitored at GSTT with histologically confirmed intermediate-risk PCa, at least 1 follow-up appointment and diagnostic characteristics consistent with AS criteria were included in the profile. Descriptive statistics, Kaplan-Meier survival curves and multivariable Cox proportion hazards regression models were used to characterize the cohort. Discussion A relatively large proportion of the cohort includes men of African/Afro-Caribbean descent (22%). More frequent use of magnetic resonance imaging and trans-perineal biopsies at diagnosis was observed among patients diagnosed after 2012. Those who underwent trans-rectal ultrasound diagnostic biopsy received their first surveillance biopsy 20 months earlier than those who underwent trans-perineal diagnostic biopsy. At 3 years, 76.1% men remained treatment free. Predictors of treatment progression included Gleason score 3 + 4 (Hazard ratio (HR): 2.41, 95% Confidence interval (CI): 1.79–3.26) and more than 2 positive cores taken at biopsy (HR: 2.65, CI: 1.94–3.62). A decreased risk of progressing to treatment was seen among men diagnosed after 2012 (HR: 0.72, CI: 0.53–0.98). Conclusion An organised biopsy surveillance approach, via two different AS pathways according to the patient’s diagnostic method, can be seen within the GSTT cohort. Risk of patients progressing to treatment has decreased in the period since 2012 compared with the prior period with more than half of the cohort remaining treatment free at 5 years, highlighting that the fundamental aims of AS at GSTT are being met. Thus, this cohort is a good resource to investigate the AS treatment pathway.

Medication for Hyperkinetic Children

PEDIATRICS ◽  
1975 ◽  
Vol 55 (4) ◽  
pp. 560-562
Author(s):  
Robert B. Kugel ◽  
Robert G. Scherz ◽  
Henry M. Seidel ◽  
Jean L. McMahon ◽  
Andrew Rinker ◽  
...  
Keyword(s):  
Drug Therapy ◽  
Prescription Drugs ◽  
Stimulant Drugs ◽  
Seizure Disorders ◽  
Physical Examinations ◽  
Hyperkinetic Child ◽  
Selection Of Patients ◽  
Selection Of

One must be cognizant of the fact that there is probably more confusion in relation to diagnosis and appropriate criteria for the use of medication for the treatment of hyperkinetic children than there is regarding the choice of medication. Many physicians, as well as the general public, do not truly appreciate the differential diagnosis of the overactive child. The symptoms may be an expression of basic personality, anxiety, subclinical seizure disorders, strictly in the eyes of the beholder, or true hyperkinesis; the latter is the only condition in which stimulants might be expected to be beneficial. The use of drug therapy in the management of the hyperkinetic child does not differ appreciably from drug therapy in other treatable maladies. In both instances prescription drugs should be prescribed only by appropriately licensed physicians. Although the screening of patients may frequently be done by other disciplines, the ultimate selection of patients remains the responsibility of the prescribing physician. Rarely is hyperkinesis an isolated symptom. Hopefully, the selection of the drug to be used is based on such factors as history and physical examinations with appropriate emphases and the weighing of risks (that is, the ramifications of the untreated patient versus side effects and long-term sequelae of medication). A satisfactory means of evaluating the effects of therapy and periodic reevaluations (follow-up) should be included. Whatever the diagnostic nomenclature, the "indications" depend largely on clinical acumen rather than pathognomonic findings. There is some agreement about the indications for the clinical use of stimulant drugs for hyperkinetic children even though there must be a trial on the medication before its efficacy can be determined for a particular child.

scholarly journals Long-Term Follow-Up of a Large Active Surveillance Cohort of Patients With Prostate Cancer

2015 ◽  
Vol 33 (3) ◽  
pp. 272-277 ◽  
Author(s):  
Laurence Klotz ◽  
Danny Vesprini ◽  
Perakaa Sethukavalan ◽  
Vibhuti Jethava ◽  
Liying Zhang ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Active Surveillance ◽  
Metastatic Disease ◽  
Specific Antigen ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Risk Prostate Cancer ◽  
Long Term Follow Up

Purpose Active surveillance is increasingly accepted as a treatment option for favorable-risk prostate cancer. Long-term follow-up has been lacking. In this study, we report the long-term outcome of a large active surveillance protocol in men with favorable-risk prostate cancer. Patients and Methods In a prospective single-arm cohort study carried out at a single academic health sciences center, 993 men with favorable- or intermediate-risk prostate cancer were managed with an initial expectant approach. Intervention was offered for a prostate-specific antigen (PSA) doubling time of less than 3 years, Gleason score progression, or unequivocal clinical progression. Main outcome measures were overall and disease-specific survival, rate of treatment, and PSA failure rate in the treated patients. Results Among the 819 survivors, the median follow-up time from the first biopsy is 6.4 years (range, 0.2 to 19.8 years). One hundred forty-nine (15%) of 993 patients died, and 844 patients are alive (censored rate, 85.0%). There were 15 deaths (1.5%) from prostate cancer. The 10- and 15-year actuarial cause-specific survival rates were 98.1% and 94.3%, respectively. An additional 13 patients (1.3%) developed metastatic disease and are alive with confirmed metastases (n = 9) or have died of other causes (n = 4). At 5, 10, and 15 years, 75.7%, 63.5%, and 55.0% of patients remained untreated and on surveillance. The cumulative hazard ratio for nonprostate-to-prostate cancer mortality was 9.2:1. Conclusion Active surveillance for favorable-risk prostate cancer is feasible and seems safe in the 15-year time frame. In our cohort, 2.8% of patients have developed metastatic disease, and 1.5% have died of prostate cancer. This mortality rate is consistent with expected mortality in favorable-risk patients managed with initial definitive intervention.

Advances in the selection of patients with prostate cancer for active surveillance

2021 ◽  
Author(s):  
James L. Liu ◽  
Hiten D. Patel ◽  
Nora M. Haney ◽  
Jonathan I. Epstein ◽  
Alan W. Partin
Keyword(s):  
Prostate Cancer ◽  
Active Surveillance ◽  
Selection Of Patients ◽  
Selection Of
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