Download or read book Active Surveillance in Men with Low to Intermediate Risk Localized Prostate Cancer written by Arnas Rakauskas and published by . This book was released on 2021 with total page 7 pages. Available in PDF, EPUB and Kindle. Book excerpt: Thèse. Biologie. Médecine. 2021.
Download or read book Active Surveillance for Localized Prostate Cancer written by Laurence Klotz and published by Springer Science & Business Media. This book was released on 2012-06-21 with total page 212 pages. Available in PDF, EPUB and Kindle. Book excerpt: 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.
Download or read book Active Surveillance for Localized Prostate Cancer written by Laurence Klotz and published by Humana Press. This book was released on 2017-09-29 with total page 249 pages. Available in PDF, EPUB and Kindle. Book excerpt: 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.
Download or read book Active Surveillance in a Cohort of Men with Prostate Cancer McGill University Experience written by Ghassan Barayan and published by . This book was released on 2016 with total page pages. Available in PDF, EPUB and Kindle. Book excerpt: "Introduction: Active surveillance (AS) is commonly recommended for men with localized low-intermediate-risk prostate cancer (PCa). The aims of our study were to evaluate clinical and pathological factors that influence the risk for disease progression in a cohort of patients with low-intermediate risk PCa under AS and to assess the probability that patients with PCa would develop unfavorable disease features (UDF) while under AS for the purpose of evaluating whether immediate hemiablation therapy (HAT) could bring clinical benefit to selected patients.Methods: We studied a total of 300 patients diagnosed between 1992 and 2012 with prostate adenocarcinoma with favorable parameters or who refused treatment and were managed with AS. Of those, 155 patients with at least 1 repeat biopsy and no progression criteria at the time of the diagnosis were included for statistical analyses. Patients were followed every 3-6 months for prostate-specific antigen (PSA) measurement and physical examination (PE). Patients were offered repeat prostatic biopsy every year. Disease progression was defined as the presence of one or more of the following criteria: ≥3 positive cores, >50% of cancer in at least 1 core, and a predominant Gleason pattern of ≥4. In our cohort of AS patients, 157 were diagnosed with unilateral PCa with ≥1 repeated biopsy. Using five different definitions of UDF, patients' data were used to simulate the theoretical outcome if these patients were managed by immediate unilateral HAT or remained on AS. Results: For the 155 patients, the mean age (SD) at diagnosis was 67 (7) years; median follow-up was 5.4 years (interquartile range [IQR], 3.6-9.5 years). Of these, 67 patients, 25 patients, 6 patients, and 2 patients had 2, 3, 4, and 5 repeat biopsies, respectively. At baseline, 11 (7%) patients had a Gleason score (GS) of 3+4, while the remaining 144 (93%) patients had a GS of ≤6. A total of 50 (32.3%) patients showed disease progression on repeat biopsies, with a median progression-free survival time of 7 years. The rate of disease progression decreased after the second repeat biopsy. The 5-year overall survival rate was 100%. Having a PSA density (PSAD) of >0.15, >1 positive core, and GS >6 at the time of the diagnosis was associated with a significantly higher rate of disease progression on univariate analysis (P0.05), while a maximum percentage of cancer in any core of 10% showed a trend toward significance for a higher progression rate (P=0.054). On multivariate analysis, only the presence of PSAD>0.15 remained significant for a higher progression rate (P0.05). Of 155 patients, 5 (3.2%) subsequently received radiotherapy, 13 (8.4%) received hormonal therapy, and 13 (8.4%) underwent radical prostatectomy. Of the 157 patients who had unilateral PCa, 144 (92%) had a Gleason score (GS) of ≤6. Using the whole range of definition for UDF, 10 to 47% of patients developed UDF while under AS. Using baseline GS, maximum percentage of cancer on any core, and PSAD, we found significant trends for higher development of UDF for patients under AS. Conclusion: AS is a suitable management option for patients with clinically low-risk PCa. A PSAD of 0.15 ng/ml/cc is an important predictor for disease progression. The majority of our patients did not develop UDF while under AS and our study thus suggests that careful patient selection for focal therapy should be performed to avoid subjecting patients to unnecessary treatment. " --
Download or read book An Evidence Review of Active Surveillance in Men with Localized Prostate Cancer written by and published by . This book was released on 2011 with total page pages. Available in PDF, EPUB and Kindle. Book excerpt: 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.
Download or read book An Evidence Review of Active Surveillance in Men with Localized Prostate Cancer written by U. S. Department of Health and Human Services and published by CreateSpace. This book was released on 2013-04-06 with total page 344 pages. Available in PDF, EPUB and Kindle. Book excerpt: 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?
Download or read book Technical Aspects of Focal Therapy in Localized Prostate Cancer written by Eric Barret and published by Springer. This book was released on 2015-01-29 with total page 252 pages. Available in PDF, EPUB and Kindle. Book excerpt: Focal therapy is a promising option for selected patients who have localized low or intermediate-risk prostate cancer, providing a compelling alternative between active surveillance and radical therapies by targeting the index lesion and preserving as much tissue as possible. Numerous cohort studies have already investigated multiple focal techniques, such as cryotherapy, high-intensity focused ultrasound, brachytherapy, photodynamic therapy, laser therapy, irreversible electroporation and cyberknife methods, all of which have demonstrated positive oncological outcomes with 70 to 90 % negative follow-up biopsy. These various ablative techniques have produced only minor side-effects concerning urinary function, a low rate of erectile dysfunction, and have demonstrated a limited rectal toxicity. As a result, the primary end-point has now shifted and a new strategy needs to be established for patient follow-up and for defining treatment failure. Written by international experts in the field, this book is mainly focused on new techniques, all of which are amply illustrated. Technical Aspects of Focal Therapy in Localized Prostate Cancer will be of great practical value to all urologists and oncologists.
Download or read book The Prostate Cancer Dilemma written by Nelson N. Stone and published by Springer. This book was released on 2015-10-19 with total page 213 pages. Available in PDF, EPUB and Kindle. Book excerpt: 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.
Download or read book Clinical Oncology written by Martin D. Abeloff and published by . This book was released on 2000 with total page 0 pages. Available in PDF, EPUB and Kindle. Book excerpt: 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.
Download or read book Strategies to Improve Adherence to Active Surveillance in Low intermediate Risk Prostate Cancer written by Janette Elizabeth Kinsella and published by . This book was released on 2019 with total page pages. Available in PDF, EPUB and Kindle. Book excerpt:
Download or read book Guidance on Using Active Surveillance to Manage Men with Low risk Prostate Cancer written by and published by . This book was released on 2015 with total page pages. Available in PDF, EPUB and Kindle. Book excerpt:
Download or read book Evidence Review of Active Surveillance in Men With Localized Prostate Cancer written by and published by . This book was released on with total page pages. Available in PDF, EPUB and Kindle. Book excerpt:
Download or read book Prostate Cancer written by Sam S. Chang and published by Springer. This book was released on 2018-05-10 with total page 202 pages. Available in PDF, EPUB and Kindle. Book excerpt: Prostate cancer is the most frequent genitourinary malignancy that garners significant medical and media attention. Over the past decade significant new discoveries have been made that have enabled substantial improvements in screening, diagnosis and management of this disease. Importantly, there has been constant evolution of the best way to treat these patients. This text will provide a single, comprehensive reference source that incorporates all the latest information regarding prostate cancer. It will serve as an easy reference source for researchers, clinicians, individuals in training, allied health professionals and medical students regarding prostate cancer by focusing on the controversial points of debate. New data regarding PSA screening, prostate cancer biomarkers, diagnostic evaluation techniques, surveillance protocols, and treatment interventions for localized and more advanced disease will be discussed. Gaps in current knowledge and areas for future research will be highlighted. Ongoing important clinical trials which could imminently yield significant new knowledge will be discussed. Uniquely to all of the above will be the clinical scenario-based format of this text. For the practicing physician, the prostate cancer screening and treatment situations will hopefully become better understood. We will incorporate key educational concepts in the framework of patient situations with evidence-based discussions of screening, diagnosis, evaluation, and therapeutic management. To provide even more insight, we plan on a comment section from leaders in the field that will be more “opinion-based” allowing the reader to get access to experienced physicians’ thought processes and practice patterns. All chapters will be authored by experts in their respective fields and incorporate original figures and illustrations to the extent possible. We anticipate that this book will quickly become the ready reference source for professionals and students in various fields with an interest in the management of a complex and multifaceted disease such as prostate cancer. The book will be comprehensive and encompass the entire the spectrum of prostate cancer. The information will be presented in a succinct and easily understandable manner so as to appeal to both scientists and clinicians.
Download or read book Adenocarcinoma of the Prostate written by Andrew W. Bruce and published by Springer Science & Business Media. This book was released on 2012-12-06 with total page 363 pages. Available in PDF, EPUB and Kindle. Book excerpt: 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.
Download or read book Strategies to Improve Adherence to Active Surveillance in Low intermediate Risk Prostate Cancer written by Janette Kinsella and published by . This book was released on 2019 with total page 0 pages. Available in PDF, EPUB and Kindle. Book excerpt: Results: Key themes influence both choice and adherence to AS, which are interlinked in respect to experience: (1) cancer characteristics (tumour volume, grade, PSA marker); (2) patient factors (age, co-morbidities, knowledge, socioeconomic status, family history, fear of progression/side-effects); (3) family and social support; (4) provider (communication, attitudes, diagnostic experience); (5) healthcare organisation (administration, education, support) and (6) health policy (guidelines, awareness). Patients and healthcare professionals have different ideas concerning the priorities for active surveillance supportive care; however, the Active Surveillance Reference Group agreed 24 consensus statements for best practice in supportive care for active surveillance in respect of; (1) principles of an active surveillance programme; (2) structure of consultations; (3) content: Information and Support; (4) delivery of information. Conclusion: Many factors influence both men's choice and adherence to AS, with health care professionals prioritising different aspects of supportive care to those of patients. It is therefore essential to implement a robust patient and public consultation process during both the evidence acquisition phase as well as the design phase of future interventions aimed at increasing AS adherence.
Download or read book Watchful Waiting Active Surveillance in Prostate Cancer Patients written by Tzuyung Doug Kou and published by . This book was released on 2008 with total page 131 pages. Available in PDF, EPUB and Kindle. Book excerpt: Prostate cancer is the most common cancer diagnosis and the second most common cancer-related death among men living in the United States. The increase in incident prostate cancer diagnosis was attributed partially to the widespread use of prostate cancer screening. African American men have higher risk of prostate cancer and cancer related mortality. In patients diagnosed with early and localized tumors, the risk of cancer specific mortality is low. Elderly men with early and localized tumors are less likely to die from prostate cancer. Various treatment options are available, but each has its own set of complications. Therefore, the dissertation study examined whether a less aggressive treatment strategy, watchful waiting active surveillance (WWAS), had any survival benefits in elderly patients. The dissertation study had three main goals. The first goal addressed two methodological issues on how treatment modalities should be captured and how WWAS should be defined. The second goal examined the effect of WWAS on survival outcomes in elderly patients over the age of 75 years. The third goal explored whether survival disparities between African American and Caucasian could be explained. The dissertation study was a population-based study using the linked Surveillance, Epidemiology, and End Results (SEER)-Medicare database. The study recommends that treatment modalities can be defined at 2 years following diagnosis. The survival benefits observed in the WWAS group relative to the No Treatment group imply that any future comparison of various treatment options needs to distinguish between those who do and do not undergo active surveillance. The study also found that in men over age 75 with early localized disease; WWAS had a much lower risk of cancer specific mortality and comparable overall survival as compared to aggressive treatment. The study results support watchful waiting with active surveillance as a desirable treatment option for older men with early and localized prostate cancer. Finally, the study found that African American prostate cancer patients continued to have greater risks of prostate cancer specific and overall mortality. The study findings suggest the importance of evaluating other non-clinical characteristics such as diet and environments, as additional ways to eliminate survival disparities.
Download or read book PET CT in Prostate Cancer written by Gary Cook and published by Springer. This book was released on 2017-07-24 with total page 73 pages. Available in PDF, EPUB and Kindle. Book excerpt: This pocket book explains the significant and well-documented impact that PET/CT can have on the management of prostate cancer through the provision of high-quality evidence regarding function and structure. Up-to-date information is supplied on the relevance of PET/CT to diagnosis, treatment planning, and therapy, including the emerging role of PET/CT with PSMA. Readers will also find clear explanation of the relation of the clinical and pathological background to imaging and the value of PET/CT compared with conventional radiological imaging. The book will be an excellent asset for referring clinicians, nuclear medicine/radiology physicians, radiographers/technologists, and nurses who routinely work in nuclear medicine and participate in multidisciplinary meetings. It is published within the Springer series Clinicians’ Guides to Radionuclide Hybrid Imaging, which presents contributions from professionals worldwide who share a common purpose in promoting nuclear medicine as an important imaging specialty for the diagnosis and management of oncological and non-oncological conditions.
