Sorveglianza Attiva update
|
|
- Osborn Gaines
- 6 years ago
- Views:
Transcription
1 Sorveglianza Attiva update Dr. Sergio Villa Dr. Riccardo Valdagni
2 Published online August 7, the main weakness of screening is a high rate of overdiagnosis (41%) p % relative reduction in prostate cancer mortality 27% relative risk reduction estimates of cumulative prostate cancer mortality one prostate cancer death averted per 781 men invited (NNI) and 27 excess cases detected (NND)
3 Not one patient with pathologically confirmed Gleason 6 only has ever died of metastatic prostate cancer Klotz M, 15-year prostate cancer mortality for conservative management of screendetected prostate cancer ranged from 0 to 2% for Gleason scores < 7 pre-screening era! screening era!
4 October 1989 February 1999 PCM - surgery (vs WW) at 10 ys relative risk : 0.56 absolute difference : 5.3% NNT to prevent one death > 20 PCM - surgery (vs WW) at 18 ys relative risk : 0.56 absolute difference : 11.0% NNT to prevent one death = 8 The goal: NNT = 1
5 Surgery (vs WW): 2.6% absolute risk reduction in mortality 12y NNT treat is ~34.5 to prevent 1 Pca death As compared with the SPCG-4, PIVOT enrolled a higher percentage of men with nonpalpable tumors (stage T1c, 50% vs. 12%) and with PSA values of 10 ng/ml November 1994 January 2002
6 Observation Involves monitoring the course of cap with the expectation of providing palliative therapy when symptoms develop or a change in exam or PSA results suggest symptoms are imminent The goal is to maintain QoL by avoiding curative treatment when prostate cancer is unlikely to cause mortality or significant morbidity Observation is applicable to elderly men or frail patients with comorbidity that will likely out-compete cap The main advantage is avoiding possible side effects of unnecessary definitive therapy or ADT Patients may be at risk for urinary retention or pathologic fracture without prior symptoms or increasing PSA level
7 Active Surveillance Involves actively monitoring the course of the disease with the expectation to intervene if the cancer progresses The goal is deferring treatment and potential side effects Active surveillance is mainly applicable to younger men with seemingly indolent cancer The advantages include: 1) avoiding the side effects of definitive therapy that may not be necessary 2) retaining QoL and normal activities 3) ensuring that small indolent cancers do not receive unnecessary treatment 4) decreasing initial costs The disadvantages include: 1) increased patient anxiety of living with an untreated cancer 2) the requirement for frequent medical examinations and periodic prostate biopsies
8 Clinical Data on CSS N of pts median age / f-up (mos) CSS (%) Roemeling (Netherland) / yr Dall Era (UCSF) / Stattin (Sweden) / yr Klotz (Toronto) / yr Soloway (Miami) / PCM at 7-10 yr median f-up: 0-2.8% Adamy (MSKCC) / Tosoian (JHU) / Ischia (PRIAS Australia) /nas 100 Bul (PRIAS) / Thomsen (Copenhagen) / Salvadurai (R. Marsden) / Valdagni (INT-Mi) / Godman (Sweden) /
9 Radical Prostatectomy Findings N of Pts Organ confined SM+ Capsular penetration pn1 Klotz et al Duffield et al % (also GPS 7) 65% (also GPS 7) n.r. n.r. 8% 15% 35% 4.2% Eggener % 8% 15% 4% v.d. Bergh nr 20.6% 11.8% 2-3% Trock et al (vs 348 PR) 73% (vs 85%) n.r 22% (vs 14%) 2% (vs 0.3%) Dall Era et al (vs 278) 79% ( vs 90%) 18% (vs 12%) 21% n.r. Cooperberg et al (vs 148) 68% (77% LR) (vs 77%) 15% (vs 9%) n.r. 0% (?) Valdagni et al % 0% 17% 0% (8 pts no LAD; 3 n.r.) Bul et al 2012 PRIAS % 24.5% n.r. 45pts: 0% 122: Nx Salvadurai % n.r 13% n.r
10 greater risk of discontinuing AS clinical stage T2 (HR: 1.63; p < 0.001) lower risk of discontinuing AS men aged yr (HR: 0.69; p < 0.001) by 5 yr, 64% of the men remained on AS
11 active surveillance is recommended for these subsets of patients (EPS > 10 y)
12
13
14 Despite this evidence, and despite guidelines recommending the use of AS, up to 90% of patients eligible for AS still undergo primary definitive therapy. Cooperberg MR. J Clin Oncol. 2010;28:1117 some patients with apparently low-risk disease actually harbour unfavourable disease due to inaccuracies in currently used (repeat) biopsy protocols Dall Era MA, et al. Eur Urol 2012; 62:976 Bul M, et al. Eur Urol 2012; 62:195
15 There is an unmet need for better tools that could be used to select patients and to monitor them
16 tumor risk patient selection communication with patient
17 tumor risk multiparametric magnetic resonance imaging (mp-mri) may provide improved predictive accuracy for correctly classifying tumors as low versus higher risk Lee DH, et al. J Urol 2013 Lee DH, et al. Jpn J Clin Oncol 2013 Guzzo TJ, et al.urol Oncol 2012 Turkbey B, et al. Radiology 2013 Ploussard G, et al. BJU Int 2011 Vargas HA, et al. J Urol 2012 Fradet V, et al. Radiology 2010 Stamatakis L, et al. Cancer 2013 Vasarainen H,et al. Scand J Urol 2013 Margel D, et al. J Urol 2012 Mullins JK, et al. BJU Int 2013 van As NJ, et al. Eur Urol 2009 Somford DM,et al. Invest Radiol 2013 Morgan VA, et al. Br J Radiol 2011 PRO Potential association with disease stage and grade over clinical criteria Additional value of multiparametric analysis and ADC High specificity for low-risk disease MRI showed sensitivity of 93%, and overall accuracy of 92% in predicting insignificant pathologic disease (tumour volume <0.5 ml, no Gleason pattern 4) outperforming Epstein, d Amico and CAPRA criteria Turkbey 2013
18 tumor risk multiparametric magnetic resonance imaging (mp-mri) may provide improved predictive accuracy for correctly classifying tumors as low versus higher risk high suspicion score on MRI showed high sensitivity ( ) for biopsy upgrading, but relatively low specificity ( ) Turkbey 2013 CON Relatively low sensitivity for higher risk disease Unsolved issues on interobserver variability, reproducibility, selection bias, costs
19 tumor risk multiparametric magnetic resonance imaging (mp-mri) may provide improved predictive accuracy for correctly classifying tumors as low versus higher risk Mp-MRI data need to be presented, using a structured reporting scheme, which consists of the following items: PI-RADS score Location and, probability of extra-prostatic disease Pertinent incidental findings CON Relatively low sensitivity for higher risk disease Unsolved issues on interobserver variability, reproducibility, selection bias, costs
20 Systematic TRUS biopsy Gleason of 6 cores GPS 3+3 GPS 3+4 GPS 4+4
21 Systematic TRUS biopsy Gleason of 6 cores GPS 3+3 GPS 3+4 GPS 4+4 Gleason of 3 cores Image-guided biopsy
22 Active surveillance Offer active surveillance (in line with recommendation 1.3.8) as an option to men with low-risk localised prostate cancer for whom radical prostatectomy or radical radiotherapy is suitable. [new 2014] Prostate cancer: diagnosis and treatment Issued: January 2014 NICE clinical guideline 175 guidance.nice.org.uk/cg Consider using the protocol in table 2 for men who have chosen active surveillance. [new 2014] Table 2 Protocol for active surveillance Timing At enrolment in active surveillance Tests (1) Multiparametric MRI if not previously performed (1) If there is concern about clinical or PSA changes at any time during active surveillance, reassess with multiparametric MRI and/or rebiopsy.
23 tumor risk improved utilization of biomarkers (PSA isoforms, phi, PCA3) will help to distinguish those patients who will most benefit from a biopsy -2proPSA: correlates with increasing GPS (p<0.001) and with cancer aggressiveness (p=0.03) THE JOURNAL OF UROLOGY Vol. 188, , October 2012 higher baseline and longitudinal -2proPSA (p ), -[2]proPSA/%fPSA (p 0.026) and PHI (p ) associated to risk reclassification during AS -2proPSA and PHI: plus biopsy tissue DNA content predictors of reclassification during Active Surveillance
24 tumor risk improved utilization of biomarkers (PSA isoforms, phi, PCA3) will help to distinguish those patients who will most benefit from a biopsy PCA3 not associated aggressiveness progression in AS PCA3 correlates with: Cancer vol > 0.5 ml ECE Positive surgical margins GPS (6 vs 7) pstage (pt0/2 vs pt3/4) % pos cores 33% vs <33%
25 patient selection Guidelines consistently recommend that patients only undergo definitive therapy for low-risk prostate cancer if they have over a 10-year life expectancy only 23% of urologists and radiation oncologists utilize prediction tools for helping to estimate their patients life expectancy Kim SP. J Urol. 2013;189:2092 there are few tools developed from contemporary cohorts for specifically predicting patients risk of nonprostate cancer mortality and existing tools require validation Kutikov A. Prostate Cancer Prostatic Dis. 2012;15:374
26 communication with patients Promotion of communication strategies regarding prognosis, risks and benefits, and shared decision making is essential to increasing patients interest in AS, particularly when most patients diagnosed with cancer are focused on the concept of cure.
27 communication with patients consultation at a multidisciplinary clinic were significantly associated with pursuit of active surveillance. (OR, 2.15; 95% CI, 1.13 to 4.10; P.02)
28 CONCLUSION 1. Indolent cancer does exist! not all prostate cancers are life threatening 2. If indolent (clinically insignificant) cancer exists, there might be a significant overtreatment 3. Delaying the definitive treatment does not appear to increase the risk of cancer progression 4. Tools to recognize indolent vs aggressive cancer are available, even if still suboptimal 5. Most men will remain in Active Surveillance
29 ACTIVE SURVEILLANCE IN INT protocols ongoing SAINT start Mar pts PRIAS start Nov pts
30 ACTIVE SURVEILLANCE IN INT eligibility criteria SAINT start Mar pts PRIAS start Nov pts ipsa 10ng/ml clinical stage T2a GPS 3+3 biopsy positive cores 20% max core length with cancer 50% ipsa 10ng/ml clinical stage T1c or T2a GPS 3+3 biopsy positive cores 2 PSAD 0.20 ng/ml/cc
31 ACTIVE SURVEILLANCE IN INT baseline patient characteristics SAINT start Mar pts PRIAS start Nov pts ipsa 10ng/ml ipsa 10ng/ml mean age at inclusion (64.4yr in PRIAS vs. 66.3yr in SAINT, t-test p=0.0014) clinical stage T2a GPS mean 3+3 PSA at diagnosis (5.3ng/ml vs. 6.9ng/ml, p<0.001) GPS 3+3 clinical stage T1c or T2a biopsy positive cores 20% biopsy positive cores 2 mean PSAd (0.11ng/ml/cc vs. 0.17ng/ml/cc, p<0.001) max core length with cancer 50% PSAD 0.20 ng/ml/cc number of core+ at diagnosis (69.6% vs. 60.5% pts with 1 core+ p=0.0005) prostate volume and clinical stages were similar
32 ACTIVE SURVEILLANCE IN INT 625 pts
33 ACTIVE SURVEILLANCE IN INT PRIAS vs SAINT
34 ACTIVE SURVEILLANCE IN INT PRIAS vs SAINT
35 ACTIVE SURVEILLANCE IN INT PRIAS vs SAINT... grazie!
Sommerakademie Munich, June
Active surveillance: Shrinking the grey zone Sommerakademie Munich, June 30 2016 Active surveillance Overview of 20 year history Laurence Klotz, MD, CM Professor of Surgery Sunnybrook Heatlh Sciences Centre
More informationACTIVE SURVEILLANCE FOR PROSTATE CANCER
ACTIVE SURVEILLANCE FOR PROSTATE CANCER Dr. Michael J Metcalfe PGY-2 Department of Urological Sciences April 25, 2012 CASE RM 65 year old active Caucasian male, married. PSA= 7.0 T2a Gleason 3+3=6 2/6
More informationPCa Commentary. Executive Summary: The "PCa risk increased directly with increasing phi values."
1101 Madison Street Suite 1101 Seattle, WA 98104 P 206-215-2490 www.seattleprostate.com PCa Commentary Volume 77 September October 2012 CONTENT Page The Prostate 1 Health Index Active Surveillance 2 A
More informationPROSTATE CANCER SURVEILLANCE
PROSTATE CANCER SURVEILLANCE ESMO Preceptorship on Prostate Cancer Singapore, 15-16 November 2017 Rosa Nadal National Cancer Institute, NIH Bethesda, USA DISCLOSURE No conflicts of interest to declare
More informationACTIVE SURVEILLANCE OR WATCHFUL WAITING
Prostate Cancer ACTIVE SURVEILLANCE OR WATCHFUL WAITING María Teresa Bourlon, MD MS Head, Urologic Oncology Clinic Hemato-Oncology Department Instituto Nacional de Ciencias Médicas y Nutrición Salvador
More informationControversies in Prostate Cancer Screening
Controversies in Prostate Cancer Screening William J Catalona, MD Northwestern University Chicago Disclosure: Beckman Coulter, a manufacturer of PSA assays, provides research support PSA Screening Recommendations
More informationDong Hoon Lee, Kyo Chul Koo, Seung Hwan Lee, Koon Ho Rha, Young Deuk Choi, Sung Joon Hong and Byung Ha Chung
Jpn J Clin Oncol 2013;43(5)553 558 doi:10.1093/jjco/hyt041 Advance Access Publication 11 April 2013 Low-risk Prostate Cancer Patients Without Visible Tumor (T1c) On Multiparametric MRI Could Qualify for
More informationConceptual basis for active surveillance
Conceptual basis for active surveillance 1. Screening results in overdiagnosis 2. Clinically insignificant disease can be identified 3. All treatments have significant side effects and cost. 4. Delayed
More informationPre-test. Prostate Cancer The Good News: Prostate Cancer Screening 2012: Putting the PSA Controversy to Rest
Pre-test Matthew R. Cooperberg, MD, MPH UCSF 40 th Annual Advances in Internal Medicine Prostate Cancer Screening 2012: Putting the PSA Controversy to Rest 1. I do not offer routine PSA screening, and
More informationPredictive role of free prostate specific antigen in a prospective active surveillance program (PRIAS)
World J Urol (2015) 33:1735 1740 DOI 10.1007/s00345-015-1542-3 ORIGINAL ARTICLE Predictive role of free prostate specific antigen in a prospective active surveillance program (PRIAS) Hanna Vasarainen 1
More informationPublished Ahead of Print on April 4, 2011 as /JCO J Clin Oncol by American Society of Clinical Oncology INTRODUCTION
Published Ahead of Print on April 4, 2011 as 10.1200/JCO.2010.32.8112 The latest version is at http://jco.ascopubs.org/cgi/doi/10.1200/jco.2010.32.8112 JOURNAL OF CLINICAL ONCOLOGY O R I G I N A L R E
More informationMR-US Fusion Guided Biopsy: Is it fulfilling expectations?
MR-US Fusion Guided Biopsy: Is it fulfilling expectations? Kenneth L. Gage MD, PhD Assistant Member Department of Diagnostic Imaging and Interventional Radiology 4 th Annual New Frontiers in Urologic Oncology
More informationJ Clin Oncol 28: by American Society of Clinical Oncology INTRODUCTION
VOLUME 28 NUMBER 1 JANUARY 1 2010 JOURNAL OF CLINICAL ONCOLOGY O R I G I N A L R E P O R T Clinical Results of Long-Term Follow-Up of a Large, Active Surveillance Cohort With Localized Prostate Cancer
More informationExpanded criteria for active surveillance in prostate cancer: a review of the current data
Review Article Expanded criteria for active surveillance in prostate cancer: a review of the current data Cameron Jones 1, Mina M. Fam 2, Benjamin J. Davies 2 1 University of Pittsburgh School of Medicine,
More informationDong Hoon Lee, Ha Bum Jung, Seung Hwan Lee, Koon Ho Rha, Young Deuk Choi, Sung Jun Hong, Seung Choul Yang and Byung Ha Chung *
Jpn J Clin Oncol 2012;42(11)1079 1085 doi:10.1093/jjco/hys147 Advance Access Publication 17 September 2012 Comparison of Pathological Outcomes of Active Surveillance Candidates Who Underwent Radical Prostatectomy
More informationBAYESIAN JOINT LONGITUDINAL-DISCRETE TIME SURVIVAL MODELS: EVALUATING BIOPSY PROTOCOLS IN ACTIVE-SURVEILLANCE STUDIES
BAYESIAN JOINT LONGITUDINAL-DISCRETE TIME SURVIVAL MODELS: EVALUATING BIOPSY PROTOCOLS IN ACTIVE-SURVEILLANCE STUDIES Lurdes Y. T. Inoue, PhD Professor Department of Biostatistics University of Washington
More informationHealth Screening Update: Prostate Cancer Zamip Patel, MD FSACOFP Convention August 1 st, 2015
Health Screening Update: Prostate Cancer Zamip Patel, MD FSACOFP Convention August 1 st, 2015 Outline Epidemiology of prostate cancer Purpose of screening Method of screening Contemporary screening trials
More informationEarly Experience With Active Surveillance in Low-Risk Prostate Cancer Treated
www.kjurology.org http://dx.doi.org/.4/kju.4...67 Original Article Urological Oncology http://crossmark.crossref.org/dialog/?doi=.4/kju.4...67&domain=pdf&date_stamp=47 Early Experience With Active Surveillance
More informationProstate Cancer: 2010 Guidelines Update
Prostate Cancer: 2010 Guidelines Update James L. Mohler, MD Chair, NCCN Prostate Cancer Panel Associate Director for Translational Research, Professor and Chair, Department of Urology, Roswell Park Cancer
More informationMr Jeremy Grummet, Urological Surgeon MBBS, MS, FRACS Foundation 49 Men s Health Symposium August 2015
www.drjeremygrummet.com.au www.aua.com.au Mr Jeremy Grummet, Urological Surgeon MBBS, MS, FRACS Foundation 49 Men s Health Symposium August 2015 The dilemma Most men die with prostate cancer rather than
More informationRisk Migration ( ct2c=high)
Risk Migration ( ctc=high) Prostate Cancer Over- Detection, but Selective Treatment Active Surveillance Peter R. Carroll, MD, MPH Department of Urology University of California, San Francisco February,
More informationEUROPEAN UROLOGY 63 (2013)
EUROPEAN UROLOGY 63 (2013) 101 107 available at www.sciencedirect.com journal homepage: www.europeanurology.com Platinum Priority Prostate Cancer Editorial by Laurence Klotz on pp. 108 110 of this issue
More informationProstate Cancer. Axiom. Overdetection Is A Small Issue. Reducing Morbidity and Mortality
Overdetection Is A Small Issue (in the context of decreasing prostate cancer mortality rates and with appropriate, effective, and high-quality treatment) Prostate Cancer Arises silently Dwells in a curable
More informationLocal Recommendations for Active Surveillance of Prostate Cancer
February 15 Local Recommendations for Active Surveillance of Prostate Cancer Chris Dawson Urology Lead Clinician February 2015 www.pchurology.co.uk Summary and Recommendations 1. There is no single set
More informationAdam Raben M.D. Helen F Graham Cancer Center
Adam Raben M.D. Helen F Graham Cancer Center Is the biopsy sample representative of the extent of the disease in your patient with clinically low-risk prostate cancer? BIOPSY RP registry (n=8095) 3+3=6
More informationStephen McManus, MD David Levi, MD
Stephen McManus, MD David Levi, MD Prostate MRI Indications INITIAL DETECTION, STAGING, RECURRENT TUMOR LOCALIZATION, RADIATION THERAPY PLANNING INITIAL DETECTION Clinically suspected prostate cancer before
More informationElevated PSA. Dr.Nesaretnam Barr Kumarakulasinghe Associate Consultant Medical Oncology National University Cancer Institute, Singapore 9 th July 2017
Elevated PSA Dr.Nesaretnam Barr Kumarakulasinghe Associate Consultant Medical Oncology National University Cancer Institute, Singapore 9 th July 2017 Issues we will cover today.. The measurement of PSA,
More informationActive surveillance: Shrinking the grey zone. Sommerakademi e Munich, June rd FOIUS Tel Aviv, July 2016
Active surveillance: Shrinking the grey zone Active surveillance: 3 rd FOIUS Tel Aviv, July 2016 Shrinking the grey zone Sommerakademi e Munich, June 30 2016 Active Surveillance for low risk PCa What has
More informationProblems: TRUS Bx. Clinical questions in PCa. Objectives. Jelle Barentsz. Prostate MR Center of Excellence.
Multi-parametric MR imaging in Problems: TRUS Bx Low Risk Prostate Cancer Important cancers are missed Jelle Barentsz Clinically insignificant cancers are identified by Prostate MR Center of Excellence
More informationUnderstanding the risk of recurrence after primary treatment for prostate cancer. Aditya Bagrodia, MD
Understanding the risk of recurrence after primary treatment for prostate cancer Aditya Bagrodia, MD Aditya.bagrodia@utsouthwestern.edu 423-967-5848 Outline and objectives Prostate cancer demographics
More informationActive Surveillance for Prostate Cancer: A Systematic Review of the Literature
EUROPEAN UROLOGY 62 (2012) 976 983 available at www.sciencedirect.com journal homepage: www.europeanurology.com Platinum Priority Collaborative Review Prostate Cancer Editorial by Gurdarshan S. Sandhu
More informationTo be covered. Screening, early diagnosis, and treatment including Active Surveillance for prostate cancer: where is Europe heading for?
To be covered Screening, early diagnosis, and treatment including Active Surveillance for prostate cancer: where is Europe heading for? Europa Uomo meeting Stockholm 29 Chris H.Bangma Rotterdam, The Netherlands
More informationLong-Term Follow-Up of a Large Active Surveillance Cohort of Patients With Prostate Cancer
Published Ahead of Print on December 15, 1 as 1.1/JCO.1.55.119 The latest version is at http://jco.ascopubs.org/cgi/doi/1.1/jco.1.55.119 JOURNAL OF CLINICAL ONCOLOGY O R I G I N A L R E P O R T Long-Term
More informationMr Declan Cahill Consultant Urological Surgeon The Royal Marsden
Diagnosing prostate cancer Mr Declan Cahill Consultant Urological Surgeon 2 Marsden GP Education Day 22 February 2016 Should I have a PSA test? Can I have a PSA test? prostatecanceruk.org 4 83% raised
More informationProstate Cancer Local or distant recurrence?
Prostate Cancer Local or distant recurrence? Diagnostic flowchart Vanessa Vilas Boas Urologist VFX Hospital FEBU PSA - only recurrence PSA recurrence: 27-53% of all patients undergoing treatment with curative
More informationUrological Society of Australia and New Zealand PSA Testing Policy 2009
Executive summary Urological Society of Australia and New Zealand PSA Testing Policy 2009 1. Prostate cancer is a major health problem and is the second leading cause of male cancer deaths in Australia
More informationProstate MRI Hamidreza Abdi, MD,FEBU Post Doctoral Fellow Vancouver Prostate Centre UBC Department of Urologic Sciences May-20144
Prostate MRI Hamidreza Abdi, MD,FEBU Post Doctoral Fellow Vancouver Prostate Centre UBC Department of Urologic Sciences May-20144 Objectives: Detection of prostate cancer the need for better imaging What
More informationProstate MRI for local staging and surgical planning in prostate cancer
Prostate MRI for local staging and surgical planning in prostate cancer 15th Annual Floyd A. Fried Advances in Urology Symposium June 23, 2017 Ray Tan, MD, MSHPM Assistant Professor Disclosures None Objectives
More informationEarly outcomes of active surveillance for localized prostate cancer
Original Article ACTIVE SURVEILLANCE FOR LOCALIZED PROSTATE CANCER HARDIE et al. Early outcomes of active surveillance for localized prostate cancer CLAIRE HARDIE, CHRIS PARKER, ANDREW NORMAN*, ROS EELES,
More informationEssential Initial Activities and Clinical Outcomes
Essential Initial Activities and Clinical Outcomes Crystal Farrell 1,2 & Sabrina L. Noyes 2, Joe Joslin 2, Manish Varma 2,3, Andrew Moriarity 2,3, Christopher Buchach 2,3, Leena Mammen 2,3, Brian R. Lane
More informationScreening and Risk Stratification of Men for Prostate Cancer Metastasis and Mortality
Screening and Risk Stratification of Men for Prostate Cancer Metastasis and Mortality Sanoj Punnen, MD, MAS Assistant Professor of Urologic Oncology University of Miami, Miller School of Medicine and Sylvester
More informationActive Surveillance (AS) is an expectant management. Health Services Research
Factors Influencing Selection of Active Surveillance for Localized Prostate Cancer Health Services Research Jianyu Liu, Paul R. Womble, Selin Merdan, David C. Miller, James E. Montie, Brian T. Denton on
More informationPathologists Perspective on Focal Therapy: The Role of Mapping Biopsies and Markers
Pathologists Perspective on Focal Therapy: The Role of Mapping Biopsies and Markers M. Scott Lucia, MD Professor and Vice Chair of Anatomic Pathology Chief of Genitourinary and Renal Pathology Dept. of
More informationSince the beginning of the prostate-specific antigen (PSA) era in the. Characteristics of Insignificant Clinical T1c Prostate Tumors
2001 Characteristics of Insignificant Clinical T1c Prostate Tumors A Contemporary Analysis Patrick J. Bastian, M.D. 1 Leslie A. Mangold, B.A., M.S. 1 Jonathan I. Epstein, M.D. 2 Alan W. Partin, M.D., Ph.D.
More informationUntreated Gleason Grade Progression on Serial Biopsies during Prostate Cancer Active Surveillance: Clinical Course and Pathological Outcomes
Untreated Gleason Grade Progression on Serial Biopsies during Prostate Cancer Active Surveillance: Clinical Course and Pathological Outcomes A. A. Hussein,* C. J. Welty,* N. Ameli,* J. E. Cowan, M. Leapman,*
More informationThe Impact of MRI-TRUS Cognitively Targeted Biopsy on the Incidence of Pathologic Upgrading After Radical Prostatectomy
Original Article World J Nephrol Urol. 2018;7(1):12-16 The Impact of MRI-TRUS Cognitively Targeted Biopsy on the Incidence of Pathologic Upgrading After Radical Prostatectomy Ragheed Saoud a, Albert El-Haj
More informationCancer. Description. Section: Surgery Effective Date: October 15, 2016 Subsection: Original Policy Date: September 9, 2011 Subject:
Subject: Saturation Biopsy for Diagnosis, Last Review Status/Date: September 2016 Page: 1 of 9 Saturation Biopsy for Diagnosis, Description Saturation biopsy of the prostate, in which more cores are obtained
More informationContemporary Approaches to Screening for Prostate Cancer
Contemporary Approaches to Screening for Prostate Cancer Gerald L. Andriole, MD Robert K. Royce Distinguished Professor Chief of Urologic Surgery Siteman Cancer Center Washington University School of Medicine
More informationDisease-specific death and metastasis do not occur in patients with Gleason score 6 at radical prostatectomy
Disease-specific death and metastasis do not occur in patients with at radical prostatectomy Charlotte F. Kweldam, Mark F. Wildhagen*, Chris H. Bangma* and Geert J.L.H. van Leenders Departments of Pathology,
More informationActive Surveillance for Intermediate Risk Prostate Cancer
Active Surveillance for Intermediate Risk Prostate Cancer Eric Wallen, M.D., FACS Professor Department of Urology The University of North Carolina at Chapel Hill Disclosures: None Objectives Understand
More informationDetection & Risk Stratification for Early Stage Prostate Cancer
Detection & Risk Stratification for Early Stage Prostate Cancer Andrew J. Stephenson, MD, FRCSC, FACS Chief, Urologic Oncology Glickman Urological and Kidney Institute Cleveland Clinic Risk Stratification:
More informationWhere are we with PSA screening?
Where are we with PSA screening? Faculty/Presenter Disclosure Rela%onships with commercial interests: None Disclosure of Commercial Support This program has received no financial support. This program
More informationProstate Cancer Who needs active surveillance?
Klinik und Poliklinik für Urologie und Kinderurologie Direktor: Prof. Dr. H. Riedmiller Prostate Cancer Who needs active surveillance? Klinische und molekulare Charakterisierung des Hoch-Risiko-Prostatakarzinoms.
More informationProstate Cancer Screening: Con. Laurence Klotz Professor of Surgery, Sunnybrook HSC University of Toronto
Prostate Cancer Screening: Con Laurence Klotz Professor of Surgery, Sunnybrook HSC University of Toronto / Why not PSA screening? Overdiagnosis Overtreatment Risk benefit ratio unfavorable Flaws of PSA
More informationProstate Cancer Screening: Risks and Benefits across the Ages
Prostate Cancer Screening: Risks and Benefits across the Ages 7 th Annual Symposium on Men s Health Continuing Progress: New Gains, New Challenges June 10, 2009 Michael J. Barry, MD General Medicine Unit
More informationState-of-the-art: vision on the future. Urology
State-of-the-art: vision on the future Urology Francesco Montorsi MD FRCS Professor and Chairman Department of Urology San Raffaele Hospital Vita-Salute San Raffaele University Milan, Italy Disclosures
More informationPSA testing in New Zealand general practice
PSA testing in New Zealand general practice Ross Lawrenson, Charis Brown, Fraser Hodgson. On behalf of the Midland Prostate Cancer Study Group Academic Steering Goup: Zuzana Obertova, Helen Conaglen, John
More informationActive surveillance: Shrinking the grey zone. Sommerakademi e Munich, June Who is the Right Patient and what is the right Protocol?
Active surveillance: Who is the Right Patient and what is the right Protocol? Active surveillance: Shrinking the grey zone Sommerakademi e Munich, June 30 2016 Or: Shrinking the Gray Zone IPCU 2017 Active
More informationPROSTATE CANCER Amit Gupta MD MPH
PROSTATE CANCER Amit Gupta MD MPH Depts. of Urology and Epidemiology Amit-Gupta-1@uiowa.edu dramitgupta@gmail.com Tel: 319-384-5251 OUTLINE PSA screening controversy How to use PSA more effectively Treatment
More informationThe role of PSA in detection and management of prostate cancer
The role of PSA in detection and management of prostate cancer Kirby R. The role of PSA in detection and management of prostate cancer. Practitioner 2016; 260(1792):17-21 Professor Roger Kirby MA MD FRCS
More informationPCa Commentary. Volume 79 May June 2014
1221 Madison Street, 1 st Floor Seattle, WA 98104 P 206-215-2480 www.seattleprostate.com PCa Commentary Volume 79 May June 2014 CONTENT: Active Surveillance Page 1 Firmagon and Lupron Page 5 ACTIVE SURVEILLANCE:
More informationNavigating the Stream: Prostate Cancer and Early Detection. Ifeanyi Ani, M.D. TPMG Urology Newport News
Navigating the Stream: Prostate Cancer and Early Detection Ifeanyi Ani, M.D. TPMG Urology Newport News Understand epidemiology of prostate cancer Discuss PSA screening and PSA controversy Review tools
More informationYiannis Philippou 1, Hary Raja 2 and Vincent J. Gnanapragasam 2*
Philippou et al. BMC Urology (2015) 15:52 DOI 10.1186/s12894-015-0049-y RESEARCH ARTICLE Open Access Active surveillance of prostate cancer: a questionnaire survey of urologists, clinical oncologists and
More informationProstate Biopsy. Prostate Biopsy. We canʼt go backwards: Screening has helped!
We canʼt go backwards: Screening has helped! Robert E. Donohue M.D. Denver V.A. Medical Center University of Colorado Prostate Biopsy Is cure necessary; when it is possible? Is cure possible; when it is
More informationProstate MRI: Who needs it?
Prostate MRI: Who needs it? Fergus Coakley MD, Professor of Radiology and Urology, Vice Chair for Clinical Services, Chief of Abdominal Imaging, UCSF Abdominal Imaging Magnetic Resonance Science Center
More informationCase Discussions: Prostate Cancer
Case Discussions: Prostate Cancer Andrew J. Stephenson, MD FRCSC FACS Chief, Urologic Oncology Glickman Urological and Kidney Institute Cleveland Clinic Elevated PSA 1 54 yo, healthy male, family Hx of
More informationProstate Biopsy in 2017
Prostate Biopsy in 2017 Bob Djavan, MD, PhD Professor and Chairman, Department of Urology, Rudolfinerhaus Foundation Hospital,Vienna, Austria Director Vienna Urology foundation Board member Scientific
More informationSaturation Biopsy for Diagnosis and Staging and Management of Prostate Cancer
Saturation Biopsy for Diagnosis and Staging and Management of Prostate Cancer Policy Number: 7.01.121 Last Review: 2/2018 Origination: 8/2006 Next Review: 8/2018 Policy Blue Cross and Blue Shield of Kansas
More informationPSA and the Future. Axel Heidenreich, Department of Urology
PSA and the Future Axel Heidenreich, Department of Urology PSA and Prostate Cancer EAU Guideline 2011 PSA is a continuous variable PSA value (ng/ml) risk of PCa, % 0 0.5 6.6 0.6 1 10.1 1.1 2 17.0 2.1 3
More informationPersonalized Therapy for Prostate Cancer due to Genetic Testings
Personalized Therapy for Prostate Cancer due to Genetic Testings Stephen J. Freedland, MD Professor of Urology Director, Center for Integrated Research on Cancer and Lifestyle Cedars-Sinai Medical Center
More informationFocus on... Prostate Health Index (PHI) Proven To Outperform Traditional PSA Screening In Predicting Clinically Significant Prostate Cancer
Focus on... Prostate Health Index (PHI) Proven To Outperform Traditional PSA Screening In Predicting Clinically Significant Prostate Cancer Prostate Cancer in Ireland & Worldwide In Ireland, prostate cancer
More informationUnderstanding the Performance of Active Surveillance Selection Criteria in Diverse Urology Practices
Understanding the Performance of Active Surveillance Selection Criteria in Diverse Urology Practices Scott R. Hawken,* Paul R. Womble,* Lindsey A. Herrel, Zaojun Ye, Susan M. Linsell, Patrick M. Hurley,
More informationActive surveillance: From Biology to Bedside. Who is Going to Fail? Active surveillance: Shrinking the grey zone. Sommerakademi e Munich, June
Active surveillance: From Biology to Bedside Who is Going to Fail? Active surveillance: Shrinking the grey zone Sommerakademi e Munich, June 30 2016 What is the main reason low risk patients fail? 1. GG1/Gleason
More information4Kscore. A Precision Test for Risk of Aggressive Prostate Cancer
4Kscore A Precision Test for Risk of Aggressive Prostate Cancer How to Evaluate Risk for Prostate Cancer? PSA is a good screening tool But abnormal PSA leads to over 1 million prostate biopsies each year
More information#1 cancer. #2 killer. Boulder has higher rate of prostate cancer compared to other areas surrounding Rocky Flats
Prostate cancer is a VERY COMMON DISEASE BREAKTHROUGHS IN THE DETECTION OF PROSTATE CANCER Carolyn M. Fronczak M.D., M.S.P.H. Urologic Surgery 303-647-9129 #1 cancer #2 killer Ca Cancer J Clin 2018;68:7
More informationAUA Update Series. Lesson 33 Volume Active Surveillance for Prostate Cancer: Patient Selection and Management
AUA Update Series Lesson 33 Volume 27 2008 Active Surveillance for Prostate Cancer: Patient Selection and Management Learning Objective: At the conclusion of this continuing medical education activity,
More informationProstate Cancer Active Surveillance: Rationale, Outcomes and Future Directions
Prostate Cancer Active Surveillance: Rationale, Outcomes and Future Directions Daniel W. Lin, MD Professor and Chief of Urologic Oncology Bridges Endowed Professorship of Prostate Cancer Research Department
More informationUtility of Prostate MRI. John R. Leyendecker, MD
Utility of Prostate MRI John R. Leyendecker, MD Professor of Radiology and Urology Executive Vice Chair of Clinical Operations Section Head, Abdominal Imaging Wake Forest University School of Medicine;
More information10/2/2018 OBJECTIVES PROSTATE HEALTH BACKGROUND THE PROSTATE HEALTH INDEX PHI*: BETTER PROSTATE CANCER DETECTION
THE PROSTATE HEALTH INDEX PHI*: BETTER PROSTATE CANCER DETECTION Lenette Walters, MS, MT(ASCP) Medical Affairs Manager Beckman Coulter, Inc. *phi is a calculation using the values from PSA, fpsa and p2psa
More informationPercent Gleason pattern 4 in stratifying the prognosis of patients with intermediate-risk prostate cancer
Review Article Percent Gleason pattern 4 in stratifying the prognosis of patients with intermediate-risk prostate cancer Meenal Sharma 1, Hiroshi Miyamoto 1,2,3 1 Department of Pathology and Laboratory
More informationFinancial Disclosures. Prostate Cancer Screening and Surgical Management
Prostate Cancer Screening and Surgical Management Dr. Ken Jacobsohn Director, Minimally Invasive Urologic Surgery Assistant Professor, Department of Urology Medical College of Wisconsin Financial Disclosures
More informationBest Papers. F. Fusco
Best Papers UROLOGY F. Fusco Best papers - 2015 RP/RT Oncological outcomes RP/RT IN ct3 Utilization trends RP/RT Complications Evolving role of elnd /Salvage LND This cohort reflects the current clinical
More informationHow to detect and investigate Prostate Cancer before TRT
How to detect and investigate Prostate Cancer before TRT Frans M.J. Debruyne Professor of Urology Andros Men s Health Institutes, The Netherlands Bruges, 25-26 September 2014 PRISM Recommendations for
More information17/07/2014. Prostate Cancer Watchful Waiting New Treatments Andrew Williams Urologist and Urological Oncologist ADHB, CMDHB and 161 Gillies Ave, Epsom
My Biases Prostate Cancer Watchful Waiting New Treatments Andrew Williams Urologist and Urological Oncologist ADHB, CMDHB and 161 Gillies Ave, Epsom I am a member of the specialist group of the Prostate
More informationAssociation of [ 2]proPSA with Biopsy Reclassification During Active Surveillance for Prostate Cancer
Association of [ 2]proPSA with Biopsy Reclassification During Active Surveillance for Prostate Cancer Jeffrey J. Tosoian,*, Stacy Loeb,*, Zhaoyong Feng, Sumit Isharwal, Patricia Landis, Debra J. Elliot,
More informationObjectives. Prostate Cancer Screening and Surgical Management
Prostate Cancer Screening and Surgical Management Dr. Ken Jacobsohn Director, Minimally Invasive Urologic Surgery Assistant Professor, Department of Urology Medical College of Wisconsin Objectives Update
More informationThe 4Kscore A Precision Test for Risk of Aggressive Prostate Cancer. Reduce Unnecessary Invasive Procedures And Healthcare Costs
The 4Kscore A Precision Test for Risk of Aggressive Prostate Cancer Reduce Unnecessary Invasive Procedures And Healthcare Costs PSA Lacks Specificity for Aggressive Prostate Cancer Abnormal PSA leads to
More informationProstate Cancer Genomics When To Treat and With What? Ashley E. Ross, M.D., Ph.D. Texas Urology Specialists August 2017
Prostate Cancer Genomics When To Treat and With What? Ashley E. Ross, M.D., Ph.D. Texas Urology Specialists August 2017 Relevant Disclosures Advisory role, ownership interest, previous unrestricted grant
More informationMy biopsy shows prostate cancer: How bad is it? How to stage prostate cancer
My biopsy shows prostate cancer: How bad is it? How to stage prostate cancer Giuseppe Petralia giuseppe.petralia@ieo.it Division of Radiology, IEO - European Institute of Oncology IRCCS, Milan Department
More informationSaturation Biopsy for Diagnosis and Staging and Management of Prostate Cancer
Saturation Biopsy for Diagnosis and Staging and Management of Prostate Cancer Policy Number: 7.01.121 Last Review: 2/2019 Origination: 8/2006 Next Review: 8/2019 Policy Blue Cross and Blue Shield of Kansas
More informationClinical Case Conference
Clinical Case Conference Intermediate-risk prostate cancer 08/06/2014 Long Pham Clinical Case 64 yo man was found to have elevated PSA of 8.65. TRUS-biopies were negative. Surveillance PSA was 7.2 in 3
More informationHigh Intensity Focused Ultrasounds for the treatment of Prostate Cancers Clinical update November D. Maruzzi - L. Ruggera
High Intensity Focused Ultrasounds for the treatment of Prostate Cancers Clinical update November 2014 D. Maruzzi - L. Ruggera HIFU development Second prototype 1995-2000 Integrated Imaging 2006-2010 1993
More informationPrognostic value of the Gleason score in prostate cancer
BJU International (22), 89, 538 542 Prognostic value of the Gleason score in prostate cancer L. EGEVAD, T. GRANFORS*, L. KARLBERG*, A. BERGH and P. STATTIN Department of Pathology and Cytology, Karolinska
More informationTechnology appraisal guidance Published: 21 November 2018 nice.org.uk/guidance/ta546
Padeliporfin for untreated localised prostate cancer Technology appraisal guidance Published: 21 November 2018 nice.org.uk/guidance/ta546 NICE 2019. All rights reserved. Subject to Notice of rights (https://www.nice.org.uk/terms-and-conditions#notice-ofrights).
More informationThe Who s of Genomic Markers: Whom to Biopsy?
The Who s of Genomic Markers: Whom to Biopsy? 1.15.17 7:20-7:40 AM E. David Crawford, M.D. Professor of Surgery/Urology/ Radiation Oncology University of Colorado WSJ 5.10.16 2 Recent Advances in Prostate
More informationClinically Localized Prostate Cancer: AUA/ASTRO/SUO Guideline Very Low-/Low-Risk Disease
Clinically Localized Prostate Cancer: AUA/ASTRO/SUO Guideline Very Low-/Low-Risk Disease Jeffrey A. Cadeddu, MD Professor, Department of Urology UT Southwestern Medical Center Vice-Chair, AUA/ASTRO/SUO
More informationProstate Cancer MRI. Accurate Diagnosis and Treatment. PSA to Prostate MRI. for patients and curious doctors
6 Prostate Cancer MRI Accurate Diagnosis and Treatment PSA to Prostate MRI for patients and curious doctors Samuel Aronson, M.D. Vincent Pelsser, M.D. Franck Bladou, M.D. Armen Aprikian, M.D. & Marc Emberton,
More informationNICE BULLETIN Diagnosis & treatment of prostate cancer
Diagnosis & treatment of prostate cancer NICE provided the content for this booklet which is independent of any company or product advertised Diagnosis and treatment of prostate cancer Introduction In
More informationProstate cancer screening: a wobble Balance. Elias NAOUM PGY-4 Urology Hotel-Dieu de France Universite Saint Joseph
Prostate cancer screening: a wobble Balance Elias NAOUM PGY-4 Urology Hotel-Dieu de France Universite Saint Joseph Epidemiology Most common non skin malignancy in men in developed countries Third leading
More informationEstimating and comparing cancer progression risks under varying surveillance protocols: moving beyond the Tower of Babel
Estimating and comparing cancer progression risks under varying surveillance protocols: moving beyond the Tower of Babel Jane Lange March 22, 2017 1 Acknowledgements Many thanks to the multiple project
More information