Abstract
Active surveillance has been proposed as an option for patients with low-risk prostate cancer in order to reduce the effects caused by overdiagnosis. Delaying treatment and applying it only if there is evidence of progression requires a careful identification of these patients. Prostate-specific antigen (PSA) serum levels lower than 10 μg/L and Gleason score lower than 7 are the main criteria used to select patients for active surveillance based on experience accumulated in the last two decades. In the selection of patients with active surveillance two points are taken into consideration: (a) Gleason score changes introduced by the Consensus Conference of 2005; (b) differences between assays in the measurement of PSA serum levels, in the selection of patients for active surveillance. Improving the accuracy of patient’s selection for active surveillance requires that Gleason score reassignment must be taken into account, as well as the harmonization between PSA assays. The use of incorrect results leads to misclassification of patients, undermining the goals of active surveillance.
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Jemal A, Bray F, Center MM, Ferlay J, Ward E, Forman D. Global cancer statistics. CA Cancer J Clin. 2011;61:69–90.
Yatani R, Chigusa I, Akazaki K, Stemmermann GN, Welsh RA, Correa P. Geographic pathology of latent prostatic carcinoma. Int J Cancer. 1982;29:611–6.
Klotz L. Low-risk prostate cancer can and should often be managed with active surveillance and selective delayed intervention. Nat Clin Pract Urol. 2008;5:2–3.
Galper SL, Chen MH, Catalona WJ, Roehl KA, Richie JP, D’Amico AV. Evidence to support a continued stage migration and decrease in prostate cancer specific mortality. J Urol. 2006;175:907–12.
Schröder FH, Hugosson J, Roobol MJ, Tammela TL, Ciatto S, Nelen V, et al. Screening and prostate-cancer mortality in a randomized European study. N Engl J Med. 2009;360:1320–8.
Etzioni R, Penson DF, Legler JM, di Tommaso D, Boer R, Gann PH, et al. Overdiagnosis due to prostate-specific antigen screening: lessons from U.S. prostate cancer Incidente Trenes. J Nat Cancer Inst. 2002;94:981–90.
Johansson JE, Andrén O, Andersson SO, Dickman PW, Holmberg L, Magnuson A, et al. Natural history of early, localized prostate cancer. JAMA. 2004;291:2713–9.
Abrahamsson PA, Artibani W, Chapple CR, Wirth M. European Association of Urology position statement on screening for prostate cancer. Eur Urol. 2009;56:270–1.
Bastian PJ, Carter BH, Bjartell A, Seitz M, Stanislaus P, Montorsi F, et al. Insignificant prostate cancer and active surveillance: from definition to clinical implications. Eur Urol. 2009;55:1321–32.
Makarov DV, Trock BJ, Humphreys EB, Mangold LA, Walsh PC, Epstein JI, et al. Updated nomogram to predict pathological stage of prostate cancer given prostate-specific antigen, clinical stage, and biopsy Gleason Score (Partin Tables) Based on Cases from 2000 to 2005. Urology. 2007;69:1095–101.
Choo R, DeBoer G, Klotz L, Danjoux C, Morton GC, Rakovitch E, et al. PSA doubling time of prostate carcinoma managed with watchful observation alone. Int J Radiat Oncol Biol Phys. 2001;50:615–20.
Choo R, Klotz L, Danjoux C, Morton GC, DeBoer G, Szumacher E, et al. 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. J Urol. 2002;167:1664–9.
Chun FK, Haese A, Ahyai SA, Walz J, Suardi N, Capitanio U, et al. Critical assessment of tools to predict clinically insignificant prostate cancer at radical prostatectomy in contemporary men. Cancer. 2008;113:701–9.
Lane JA, Hamdy FC, Martin RM, Turner EL, Neal DE, Donovan JL. Latest results from the UK trials evaluating prostate cancer screening and treatment: the CAP and ProtecT studies. Eur J Cancer. 2010;46:3095–101.
van den Bergh RCN, Roemeling S, Roobol MJ, Roobol W, Schröder FH, Bangma CH. Prospective validation of active surveillance in prostate cancer: the PRIAS Study. Eur Urol. 2007;52:1560–3.
Klotz L. Active surveillance for prostate cancer: patient selection and management. Curr Oncol. 2010;17 Suppl 2:S11–7.
Heidenreich A, Bellmunt J, Bolla M, Joniau S, Mason M, Matveev V, et al. EAU Guidelines on Prostate Cancer. Part 1: screening, diagnosis, and treatment of clinically localised disease. Eur Urol. 2011;59:61–71.
Ghani KR, Grigor K, Tulloch DN, Bollina PR, McNeill SA. PSA doubling time of prostate carcinoma managed with watchful observation alone. Eur Urol. 2005;47:196–201.
Albertsen PC, Hanley JA, Barrows GH, Penson DF, Kowalczyk PDH, Sanders MM, et al. Prostate cancer and the Will Rogers phenomenon. J Natl Cancer Inst. 2005;97:1248–53.
Epstein JI, Allsbrook WC, Amin MB, Elevad LL, the ISUP Grading Comité. The 2005 International Society of Urological Pathology (ISUP) Consensus Conference on Gleason Grading of Prostatic Carcinoma. Am J Surg Pathol. 2005;29:1228–42.
Chan TY, Partin AW, Walsh PC, Epstein JL. Prognostic significance of Gleason score 3 + 4 versus Gleason score 4 + 3 tumor at radical prostatectomy. Urology. 2000;56:823–7.
Herman CM, Kattan MW, Ohori M, Scardino PT, Wheeler TM. Primary Gleason pattern as a predictor of disease progresión in Gleason score 7 prostate cancer: a multivariate analysis of 823 men treated with radical prostatectomy. Am J Surg Pathol. 2001;25:657–60.
Lau WK, Blute ML, Bostwick DG, Weaver AL, Sebo TJ, Zincke H. Prognostic factors for survival of patients with pathological Gleason score 7 prostate cancer: differences in outcome between primary Gleason grades 3 and 4. J Urol. 2001;166:1692–7.
Wright JL, Salinas CA, Lin DW, Kolb S, Koopmeiners J, Feng Z, et al. Prostate cancer specific mortality and Gleason 7 disease differences in prostate cancer outcomes between cases with Gleason 4 _ 3 and Gleason 3 _ 4 tumors in a population based cohort. J Urol. 2009;182:2702–7.
Klotz L. Low-risk prostate cancer can and should often be managed with active surveillance and selective delayed intervention. Nat Clin Parcticae Urol. 2008;5:2–3.
Semjonow A, Brandt B, Oberpenning F, Roth S, Hertle L. Discordance Prostate Suppl. 1996;7:3–16.
Jarrigue V. The need for a lower total PSA cut-off value with PSA assays calibrated to the new WHO standard. Clinical Laboratory International April 2007.
Jansen FH, Roobol M, Bangma CH, van Schaik RH. Clinical impact of new prostate-specific antigen WHO standardization on biopsy rates and cancer detection. Clin Chem. 2008;54:1999–2006.
Stephan C, Klaas M, Müller C, Schnorr D, Loening SA, Jung K. Interchangeability of measurements of total and free prostate-specific antigen in serum with 5 frequently used assay combinations: an update. Clin Chem. 2006;52:59–64.
Stephan C, Kramer J, Meyer HA, Kristiansen G, Ziemer S, Deger S, et al. Different prostate-specific antigen assays give different results on the same blood sample: an obstacle to recommending uniform limits for prostate biopsies. BJU Int. 2007;99:1427–31.
Slev PR, La’ulu SL, Roberts WL. Intermethod differences in results for total PSA, free PSA, and percentage of free PSA. Am J Clin Pathol. 2008;129:952–8.
Sturgeon C, Dati F, Duffy MJ, Hasholzner U, Klapdor R, Lamerz R, et al. Quality requirements and control: EGTM recommendations. European Group on Tumour Markers. Anticancer Res. 1999;19:2791–4.
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Filella, X., Alcover, J. & Molina, R. Active surveillance in prostate cancer: the need to standardize. Tumor Biol. 32, 839–843 (2011). https://doi.org/10.1007/s13277-011-0193-2
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DOI: https://doi.org/10.1007/s13277-011-0193-2