TY - JOUR
T1 - Preventing clinical progression and need for treatment in patients on active surveillance for prostate cancer
AU - Goldberg, Hanan
AU - Klaassen, Zachary
AU - Chandrasekar, Thenappan
AU - Fleshner, Neil
N1 - Publisher Copyright:
Copyright © 2017 Wolters Kluwer Health, Inc. All rights reserved.
PY - 2018/1/1
Y1 - 2018/1/1
N2 - Purpose of review Active surveillance is an established treatment option for men with localized, low-risk prostate cancer (CaP). It entails the postponement of immediate therapy with the option of delayed intervention upon disease progression. The rate of clinical progression and need for treatment on active surveillance is approximately 50% over 15 years. The present review summarizes recent data on current methods, attempting to prevent clinical progression. Recent findings Patient selection for active surveillance is the first mandatory step required to lower progression. Adherence to active surveillance protocols is critical in making sure patients are monitored well and treated early when progression occurs. Before active surveillance allocation and during active surveillance follow-up, methods involving multiparametric MRI, prostate specific antigen derivatives, biopsy factors, urinary, tissue and genetic markers can be used to prevent clinical progression and/or identify those at risk for progression. Medications such as 5a-reductase inhibitors and others might inhibit disease progression in patients on active surveillance. Summary Active surveillance is required because of overdiagnosis, along with our inability to accurately predict individual CaP behavior. Several methods can potentially reduce the risk of CaP progression in patients with active surveillance. However, a measure of uncertainty and fear of progression will always accompany patients with active surveillance and the physicians treating them.
AB - Purpose of review Active surveillance is an established treatment option for men with localized, low-risk prostate cancer (CaP). It entails the postponement of immediate therapy with the option of delayed intervention upon disease progression. The rate of clinical progression and need for treatment on active surveillance is approximately 50% over 15 years. The present review summarizes recent data on current methods, attempting to prevent clinical progression. Recent findings Patient selection for active surveillance is the first mandatory step required to lower progression. Adherence to active surveillance protocols is critical in making sure patients are monitored well and treated early when progression occurs. Before active surveillance allocation and during active surveillance follow-up, methods involving multiparametric MRI, prostate specific antigen derivatives, biopsy factors, urinary, tissue and genetic markers can be used to prevent clinical progression and/or identify those at risk for progression. Medications such as 5a-reductase inhibitors and others might inhibit disease progression in patients on active surveillance. Summary Active surveillance is required because of overdiagnosis, along with our inability to accurately predict individual CaP behavior. Several methods can potentially reduce the risk of CaP progression in patients with active surveillance. However, a measure of uncertainty and fear of progression will always accompany patients with active surveillance and the physicians treating them.
KW - 5a-reductase inhibitor
KW - Active surveillance
KW - Multiparametric MRI
KW - Progression
KW - Prostate specific antigen
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U2 - 10.1097/MOU.0000000000000455
DO - 10.1097/MOU.0000000000000455
M3 - Review article
C2 - 29028765
AN - SCOPUS:85036509722
SN - 0963-0643
VL - 28
SP - 46
EP - 54
JO - Current Opinion in Urology
JF - Current Opinion in Urology
IS - 1
ER -