Active surveillance; A reasonable management alternative for patients with prostate cancer: The Miami experience
ABSTRACT To examine the outcome of patients diagnosed with 'low-risk' prostate cancer managed by active surveillance (AS).
In all, 157 men with localized prostate cancer were followed on AS. The inclusion criteria for AS included: Gleason score of < or = 6, a serum prostate-specific antigen (PSA) level of < or = 15 ng/mL, stage < or = T2, low-volume disease and > 12 months of follow-up. The follow-up was rigorous, with PSA tests and a digital rectal examination every 3 months for 2 years, and a repeat biopsy 6-12 months after the initial diagnosis and yearly when indicated. Continuance of AS was based on the PSA doubling time, re-biopsy score, Gleason score, tumour volume, stage progression and patient preference.
In all 99 patients met the inclusion criteria; their mean age at diagnosis was 66 years, their mean PSA level 5.77 ng/mL and the mean follow-up 45.3 months. On initial repeat biopsy, 63% had no cancer and 34% had a Gleason sum of < or = 6. Eight patients were treated (three with hormones; five with curative intent); two had radical prostatectomy (one had pT2c pNO Gleason 7 disease); three had radiotherapy. The probability is that 85% would remain treatment-free at 5 years; no patient died from prostate cancer. The PSA doubling time and clinical stage at diagnosis were predictive of progression.
Patients who are followed on AS must be selected using narrowly defined inclusion criteria and closely followed with a standard regimen of PSA testing, digital rectal examination and repeat biopsy.
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- "Waning sexual function may be a common diseasespecific concern for patients with PCa  . Beginning in 2007, all men with a diagnosis of PCa were asked to complete the SHIM. "
ABSTRACT: With the advent of prostate-specific antigen (PSA) screening and the increase in the number of transrectal ultrasound-guided biopsy cores, there has been a dramatic rise in the incidence of low-risk prostate cancer (LRPC). Because > 97% of men with LRPC are likely to die of something other than prostate cancer, it is critical that patients give thought to whether early curative treatment is the only option at diagnosis. To identify a group of men with LRPC who may not require initial treatment and monitor them on our active surveillance (AS) protocol, to determine the percentage treated and the outcome and to analyze the quality-of-life data. We defined patients eligible for AS as Gleason ≤ 6, PSA ≤ 10, and two or fewer biopsy cores with ≤ 20% tumor in each core. Kaplan Meier analysis was used to predict the 5-year treatment free survival. Logistic regression determined the predictors of treatment. Data on sexual function, continence, and outcome were obtained and analyzed. The AS cohort consisted of 230 patients with a mean age of 63.4 yr; 86% remained on AS for a mean follow-up of 44 mo. Thirty-two of the 230 patients (14%) were treated for a mean follow-up of 33 mo. Twelve had a total prostatectomy (TP). The pathologic stage of these patients was similar to initially treated TP patients with LRPC. Fourteen underwent radiation therapy, and six underwent androgen-deprivation therapy. Fifty percent of patients had no tumor on the first rebiopsy, and only 5% of these patients were subsequently treated. PSA doubling time and clinical stage were not predictors of treatment. No patient progressed after treatment. Among the AS patients, 30% had incontinence, yet < 15% were bothered by it. As measured by the Sexual Health Inventory for Men, 49% of patients had, at a minimum, moderate (≤ 16) erectile dysfunction. If guidelines for AS are narrowly defined to include only patients with Gleason 6, tumor volume ≤ 20% in one or two biopsy cores, and PSA levels ≤ 10, few patients are likely to require treatment. Progression-free survival of those treated is likely to be equivalent to patients with similar clinical findings treated at diagnosis.European Urology 12/2010; 58(6):831-5. DOI:10.1016/j.eururo.2010.08.027 · 12.48 Impact Factor
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ABSTRACT: Recent results indicate that tumour necrosis factor alpha (TNFalpha) may have an important role in the pathogenesis of silicosis. Supernatants of macrophages exposed to quartz and coal mine dust were tested for the presence of TNFalpha. Monocytes were isolated from peripheral blood and cultured for 10-14 days. After in vitro maturation of monocytes to cells with characteristics of macrophages, they were incubated with quartz dust DQ12 and various coal mine dusts from the Ruhr Valley for 24 hr. TNFalpha bioactivity in the supernatants of dust-treated macrophages was measured in a cytotoxicity bioassay with L929-mouse fibroblasts. Endotoxin, the lipopolysaccharide-containing cell wall component of Gram-negative bacteria, is the most important stimulator of TNFalpha induction in human macrophages. Suspensions of coal mine dusts from the Ruhr Valley and quartz dust DQ12 were therefore analysed for the presence of endotoxin by the very sensitive Limulus amoebocytes lysate test. Only a few suspensions of coal mine dusts from the Ruhr Valley contained endotoxin. Only endotoxin-containing dusts stimulated macrophages to produce TNFalpha. Incubating human pneumocytes type II (line A-549) with TNFalpha as the pure substance led to a transformation of these epithelial cells into spindle-shaped cells. This morphological transformation was accompanied by marked inhibition of pneumocyte type II proliferation.Toxicology in Vitro 08/1995; 9(4):403-9. DOI:10.1016/0887-2333(95)00026-5 · 3.21 Impact Factor