Maria Komisarenko1, Narhari Timilshina1, Patrick O Richard1, Shabbir M H Alibhai2, Robert Hamilton1, Girish Kulkarni1, Alexandre Zlotta1, Neil Fleshner1, Antonio Finelli3. 1. Division of Urology, Departments of Surgery and Surgical Oncology, Princess Margaret Cancer Centre, University Health Network and the University of Toronto, Toronto, Ontario, Canada. 2. Department of Medicine, University Health Network and the University of Toronto, Toronto, Ontario, Canada. 3. Division of Urology, Departments of Surgery and Surgical Oncology, Princess Margaret Cancer Centre, University Health Network and the University of Toronto, Toronto, Ontario, Canada. Electronic address: antonio.finelli@uhn.ca.
Abstract
PURPOSE: We reviewed various existing active surveillance criteria and determined the competing trade-offs of the stricter vs more inclusive active surveillance criteria. MATERIALS AND METHODS: Men enrolled in an active surveillance program at Princess Margaret Cancer Centre between 1998 and 2014 were identified through a prospectively maintained database. All patients were assessed for entry eligibility into the Prostate Cancer Research International: Active Surveillance, Johns Hopkins, University of Miami, University of California San Francisco, Memorial Sloan Kettering Cancer Center, University of Toronto-Sunnybrook and Royal Marsden protocols. The 2-sided t-test, ANOVA, Wilcoxon rank sum or chi-square tests were used for comparison as appropriate. RESULTS: Of the 1,365 men identified 1,085 met the Princess Margaret Cancer Centre inclusion criteria. When the Johns Hopkins, Prostate Cancer Research International: Active Surveillance and University of Miami criteria were applied 15.2%, 11.5% and 11.3% of these patients were excluded from active surveillance, respectively. No significant differences were noted between men who met the Princess Margaret Cancer Centre criteria and those who were excluded based on more stringent criteria when grade or volume reclassification was compared. No significant differences in prostate specific antigen velocity or the number of patients who proceeded to seek treatment were noted (p >0.1). Rates of biochemical recurrence among patients who chose to undergo radical prostatectomy after initial active surveillance were not different between men who met the more inclusive vs more exclusive active surveillance protocols. CONCLUSIONS: More selective criteria do not significantly improve short-term outcomes when considering the relative risk of grade reclassification or biochemical failure after treatment. In an era of increased awareness regarding the over diagnosis and overtreatment of prostate cancer, we believe that stricter entry criteria should be reconsidered.
PURPOSE: We reviewed various existing active surveillance criteria and determined the competing trade-offs of the stricter vs more inclusive active surveillance criteria. MATERIALS AND METHODS:Men enrolled in an active surveillance program at Princess Margaret Cancer Centre between 1998 and 2014 were identified through a prospectively maintained database. All patients were assessed for entry eligibility into the Prostate Cancer Research International: Active Surveillance, Johns Hopkins, University of Miami, University of California San Francisco, Memorial Sloan Kettering Cancer Center, University of Toronto-Sunnybrook and Royal Marsden protocols. The 2-sided t-test, ANOVA, Wilcoxon rank sum or chi-square tests were used for comparison as appropriate. RESULTS: Of the 1,365 men identified 1,085 met the Princess Margaret Cancer Centre inclusion criteria. When the Johns Hopkins, Prostate Cancer Research International: Active Surveillance and University of Miami criteria were applied 15.2%, 11.5% and 11.3% of these patients were excluded from active surveillance, respectively. No significant differences were noted between men who met the Princess Margaret Cancer Centre criteria and those who were excluded based on more stringent criteria when grade or volume reclassification was compared. No significant differences in prostate specific antigen velocity or the number of patients who proceeded to seek treatment were noted (p >0.1). Rates of biochemical recurrence among patients who chose to undergo radical prostatectomy after initial active surveillance were not different between men who met the more inclusive vs more exclusive active surveillance protocols. CONCLUSIONS: More selective criteria do not significantly improve short-term outcomes when considering the relative risk of grade reclassification or biochemical failure after treatment. In an era of increased awareness regarding the over diagnosis and overtreatment of prostate cancer, we believe that stricter entry criteria should be reconsidered.
Authors: Guan Hee Tan; Antonio Finelli; Ardalan Ahmad; Marian S Wettstein; Thenappan Chandrasekar; Alexandre R Zlotta; Neil E Fleshner; Robert J Hamilton; Girish S Kulkarni; Khaled Ajib; Gregory Nason; Nathan Perlis Journal: Can Urol Assoc J Date: 2019-08-31 Impact factor: 1.862
Authors: François Audenet; Emily A Vertosick; Samson W Fine; Daniel D Sjoberg; Andrew J Vickers; Victor E Reuter; James A Eastham; Peter T Scardino; Karim A Touijer Journal: J Urol Date: 2017-10-10 Impact factor: 7.450
Authors: Rano Matta; Amanda E Hird; Erind Dvorani; Refik Saskin; Gregory J Nason; Girish Kulkarni; Ronald T Kodama; Sender Herschorn; Robert K Nam Journal: Cancer Med Date: 2020-08-05 Impact factor: 4.452