Is there still a role for active surveillance in prostate cancer?

Der Urologe. Ausg. A
M Stöckle

Abstract

Long-term data demonstrate a higher oncological risk associated with active surveillance (AS) than initially anticipated. In particular, patients with more than two tumor-involved biopsy cores and/or Gleason-7a foci must be regarded as having an increased risk of developing an incurable stage of disease after an initial attempt of AS. For patients with Gleason-7a foci, the 15-year risk of suffering from an incurable tumor stage is reported as high as 60%. Furthermore, life expectancy must be regarded as one of the major risk factors to finally develop symptomatic incurable disease. A discussion has therefore started as to whether a high life expectancy should be regarded as an exclusion criterion against AS. An estimated life expectancy exceeding 15 or 20 years has been proposed for patients suffering from Gleason 7a or 6 foci at initial biopsy, respectively. Furthermore, it must be expected that a number of molecular risk factors will gain importance in the near future for the decision-making process for or against AS.

References

Apr 26, 2012·The American Journal of Surgical Pathology·Hillary M RossJonathan I Epstein
Jul 20, 2012·The New England Journal of Medicine·Timothy J WiltUNKNOWN Prostate Cancer Intervention versus Observation Trial (PIVOT) Study Group
Oct 19, 2013·The Journal of Clinical Investigation·Michael C HaffnerSrinivasan Yegnasubramanian
Mar 7, 2014·The New England Journal of Medicine·Anna Bill-AxelsonJan-Erik Johansson
Mar 19, 2014·Journal of Clinical Oncology : Official Journal of the American Society of Clinical Oncology·Michael C HaffnerH Ballentine Carter
Nov 20, 2014·Canadian Urological Association Journal = Journal De L'Association Des Urologues Du Canada·Paul TorenAntonio Finelli
Dec 17, 2014·Journal of Clinical Oncology : Official Journal of the American Society of Clinical Oncology·Laurence KlotzAndrew Loblaw
Sep 15, 2016·The New England Journal of Medicine·Freddie C HamdyUNKNOWN ProtecT Study Group

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Citations

Nov 9, 2021·Der Urologe. Ausg. A·Zaid Al-KailaniMatthias Saar

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