Early Experience With Active Surveillance in Low-Risk Prostate Cancer Treated

다국어 초록 (Multilingual Abstract)

Purpose: This study was conducted to describe our early experience with active surveillance(AS).
Materials and Methods: Between January 2008 and December 2012, 35 patients weretreated with AS. Selection criteria included the following: Gleason score ≤6 with singlepositive core, clinical stage ≤T1c, prostate-specific antigen (PSA) ≤10 ng/mL, and unremarkableimaging results. On patient follow-up, we regularly measured PSA (every3–6 months) and performed prostate biopsies (after 1 and 3 years).
Results: In the first year of follow-up, prostate biopsies were performed in 25 patients(13 patients, negative for cancer; 7 patients, Gleason score of 6 without progression;5 patients, progression, treated with radical prostatectomy [RP]). In the third year offollow-up, prostate biopsies were performed in five patients (two patients, negative forcancer; one patient, Gleason score of 6 without progression; two patients, progression,treated with RP). Seven patients discontinued AS because of increased anxiety, andthree patients were lost to follow-up. Overall, seven patients (28%) who experiencedprogression had a mean PSA doubling time (DT) of 7.54 years. Six patients had a PSADT of more than 3 years, whereas one had a PSA DT of less than 3 years. This studywas limited by its small sample size and short follow-up period.
Conclusions: PSA kinetics did not correlate with progression, which suggests that regularbiopsies should still be performed. AS is an available treatment option for patientswith a low risk of prostate cancer but should only be used in carefully selected patients.

참고문헌 (Reference)

1 정재승, "확대 전립선 생검을 통해 저위험성으로 확인된 국소전립선암의 근치적 전립선적출술 후 병리학적 결과" 대한비뇨기과학회 49 (49): 874-878, 2008

2 Berglund RK, "athological upgrading and up staging with immediate repeat biopsy in patients eligible for active surveillance" 180 : 1964-1967, 2008

3 Barocas DA, "What percentage of patients with newly diagnosed carcinoma of the prostate are candidates for surveillance? An analysis of the CaPSURE database" 180 : 1330-1334, 2008

4 National Cancer Center, "The statistics report: the incidence of cancer on 1999-2011 and the survival rate on 2012"

5 Whitson JM, "The relationship between prostate specific antigen change and biopsy progression in patients on active surveillance for prostate cancer" 185 : 1656-1660, 2011

6 안홍재, "Single Positive Core Prostate Cancer in a 12-Core Transrectal Biopsy Scheme: Clinicopathological Implications Compared with Multifocal Counterpart" 대한비뇨기과학회 51 (51): 671-676, 2010

7 Park SK, "Rising prostate cancer rates in South Korea" 66 : 1285-1291, 2006

8 Ross AE, "Prostate-specific antigen kinetics during follow-up are an unreliable trigger for intervention in a prostate cancer surveillance program" 28 : 2810-2816, 2010

9 Fradet V, "Prostate cancer managed with active surveillance:role of anatomic MR imaging and MR spectroscopic imaging" 256 : 176-183, 2010

10 Kakehi Y, "Prospective evaluation of selection criteria for active surveillance in Japanese patients with stage T1cN0M0prostate cancer" 38 : 122-128, 2008

11 van As NJ, "Predicting the probability of deferred radical treatment for localised prostate cancer managed by active surveillance" 54 : 1297-1305, 2008

12 Epstein JI, "Pathologic and clinical findings to predict tumor extent of nonpalpable (stage T1c) prostate cancer" 271 : 368-374, 1994

13 Reynard J, "Oxford handbook of urology" Oxford University Press 2010

14 van den Bergh RC, "Outcomes of men with screen-detected prostate cancer eligible for active surveillance who were managed expectantly" 55 : 1-8, 2009

15 김성철, "Gleason 점수 6 전립선암의 술 후 Upgrading 및 Upstaging을 예측하는 인자" 대한비뇨기과학회 50 (50): 836-842, 2009

16 Choo R, "Feasibility study: watchful waiting for localized low to intermediate grade prostate carcinoma with selective delayed intervention based on prostate specific antigen, histological and/or clinical progression" 167 : 1664-1669, 2002

17 Carter HB, "Expectant management of nonpalpable prostate cancer with curative intent: preliminary results" 167 : 1231-1234, 2002

18 Fowler FJ Jr, "Comparison of recommendations by urologists and radiation oncologists for treatment of clinically localized prostate cancer" 283 : 3217-3222, 2000

19 Afaq A, "Clinical utility of diffusion-weighted magnetic resonance imaging in prostate cancer" 108 : 1716-1722, 2011

20 Klotz L, "Clinical results of long-term follow-up of a large, active surveillance cohort with localized prostate cancer" 28 : 126-131, 2010

21 Bastian PJ, "Characteristics of insignificant clinical T1c prostate tumors: a contemporary analysis" 101 : 2001-2005, 2004

22 Lee SE, "Application of the Epstein criteria for prediction of clinically insignificant prostate cancer in Korean men" 105 : 1526-1530, 2010

23 Soloway MS, "Active surveillance; a reasonable management alternative for patients with prostate cancer: the Miami experience" 101 : 165-169, 2008

24 Tosoian JJ, "Active surveillance program for prostate cancer: an update of the Johns Hopkins experience" 29 : 2185-2190, 2011

25 Dall'Era MA, "Active surveillance for the management of prostate cancer in a contemporary cohort" 112 : 2664-2670, 2008

26 Cooperberg MR, "Active surveillance for prostate cancer: progress and promise" 29 : 3669-3676, 2011

27 Dall'Era MA, "Active surveillance for prostate cancer: a systematic review of the literature" 62 : 976-983, 2012

28 Klotz L, "Active surveillance for favorable-risk prostate cancer:who, how and why?" 4 : 692-698, 2007

29 Nathan Lawrentschuk, "Active Surveillance for Favorable-Risk Prostate Cancer: A Short Review" 대한비뇨기과학회 51 (51): 665-670, 2010