Active surveillance - Is it feasible for intermediate-risk localised prostate cancer?

Journal article

Subhabrata Mukherjee, Ioannis Promponas, Neophytos Petrides, Dafader Hossain, Jayasimha Abbaraju and Sanjeev Madaan 2021. Active surveillance - Is it feasible for intermediate-risk localised prostate cancer? European Urology Open Science. 24, pp. 17-24. https://doi.org/10.1016/j.euros.2020.12.005
AuthorsSubhabrata Mukherjee, Ioannis Promponas, Neophytos Petrides, Dafader Hossain, Jayasimha Abbaraju and Sanjeev Madaan
Abstract

Background
Although active surveillance (AS) is a well-recognised treatment option for localised low-risk prostate cancer (LRPC), its role in the management of localised intermediate-risk prostate cancer (IRPC) is not clear yet and the available literature is slightly contradictory.

Objective
To compare the outcome of AS between LRPC and IRPC patients.

Design, setting, and participants
Between November 2002 and August 2019, 372 men with localised prostate cancer (PC) underwent AS in our hospital based on local departmental protocol.

Outcome measurements and statistical analysis
The primary outcome measures were overall survival, disease progression–free survival, treatment-free survival, and biochemical recurrence–free survival. Survival times in the low- and intermediate-risk groups were compared using Cox regression analysis.

Results and limitations
Out of 372 localised PC patients, 276 (74%) had LRPC and 96 (26%) IRPC. Overall, 86 (31.2%) low-risk and 25 (26%) intermediate-risk patients developed disease progression, and 86 (31.2%) low-risk and 22 (23%) intermediate-risk patients underwent active treatment. Among the treated patients, eight (2.9%) LRPC patients and one (1%) IRPC patient developed biochemical recurrence. In total, only one patient (from the low-risk group) had metastasis and 25 patients passed away (18 from the low-risk and seven from the intermediate-risk group). No death was recorded due to PC in the cohort. There was no difference in any of the survival outcomes between LRPC and IRPC patients in unadjusted analysis as well as when analysis was performed after adjusting the potentially confounding factors. Limitations include relatively short median follow-up time and failure to objectively define the criteria for the selection of IRPC patients suitable for AS.

Conclusions
The option of AS could be considered for carefully selected and well-informed patients with IRPC provided close structured monitoring is maintained.

Patient summary
In this report, we looked at various survival outcomes of active surveillance between low- and intermediate-risk prostate cancer patients in a large British population. There was no difference in any of the survival outcomes between the two groups. We concluded that carefully selected intermediate-risk prostate cancer patients could be offed the option of active surveillance.

KeywordsProstate cancer; Active surveillance; Low-risk prostate cancer; Intermediate-risk prostate cancer; Prostate-specific antigen; Magnetic resonance imaging
Year2021
JournalEuropean Urology Open Science
Journal citation24, pp. 17-24
PublisherElsevier
ISSN2666-1683
Digital Object Identifier (DOI)https://doi.org/10.1016/j.euros.2020.12.005
Official URLhttps://doi.org/10.1016/j.euros.2020.12.005
Publication dates
Online08 Jan 2021
Publication process dates
Accepted08 Dec 2020
Deposited02 Dec 2021
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Faqar Anjum, Senthy Sellaturay, Phauda Thebe, Ian Dickinson, Seshadri Sriprasad and Sanjeev Madaan 2012. Benign schwannoma of seminal vesicle presenting as haematospermia. Journal of Clinical Urology. 5 (3), pp. 137-139. https://doi.org/10.1016/j.bjmsu.2011.06.003
Submucosal ureteric calculus mimicking transitional cell carcinoma
Madaan, S., Bardapure, M., Nagarajan, M. and Biyani, C. S. 2010. Submucosal ureteric calculus mimicking transitional cell carcinoma. International Journal of Clinical Practice. 64 (1), pp. 131-133. https://doi.org/10.1111/j.1742-1241.2006.01070.x
A giant bladder calculus with a synchronous giant secondary vaginal stone: a case report
Miah, S., Madaan, S., Khan, M., Urwin, G. and Stower, M. 2009. A giant bladder calculus with a synchronous giant secondary vaginal stone: a case report. Current Urology. 2 (4), pp. 206-207. https://doi.org/10.1159/000209835
Segmental testicular infarction: conservative management is feasible and safe
Sanjeev Madaan, Steven Joniau, Katrien Klockaerts, Liesbeth DeWever, Evelyne Lerut, Raymond Oyen and Hendrik Van Poppel 2008. Segmental testicular infarction: conservative management is feasible and safe. European Urology. 52 (2), pp. 441-445. https://doi.org/10.1016/j.eururo.2007.03.061
Segmental testicular infarction. Conservative management is feasible and safe: part 2
Sanjeev Madaan, Steven Joniau, Katrien Klockaerts, Liesbeth DeWever, Evelyne Lerut, Raymond Oyen and Hendrik Van Poppel 2007. Segmental testicular infarction. Conservative management is feasible and safe: part 2. European Urology. 53 (3), pp. 656-658. https://doi.org/10.1016/j.eururo.2007.03.062
Key clinical issues in renal cancer: a challenge for proteomics
Rosamonde E. Bank, Rachel A. Craven, Patricia Harnden, Sanjeev Madaan, Adrian Joyce and Peter J. Selby 2007. Key clinical issues in renal cancer: a challenge for proteomics. World Journal of Urology. 25, pp. 537-556. https://doi.org/10.1007/s00345-007-0199-y
Unusual squamous cell carcinoma of the scrotum arising from a well healed, innocuous scar of an infertility procedure: a case report
Sanjeev Kotwal, Sanjeev Madaan, Stephen Prescott, Sameer Chilka and Peter Whelan 2007. Unusual squamous cell carcinoma of the scrotum arising from a well healed, innocuous scar of an infertility procedure: a case report. Annals of the Royal College of Surgeons of England. 89 (5), pp. W17-W-19. https://doi.org/10.1308/147870807X188498
Limitations of extracorporeal shock wave lithotripsy
Madaan, S. and Joyce, A. 2007. Limitations of extracorporeal shock wave lithotripsy. Current Opinion in Urology. 17 (2), pp. 109-113. https://doi.org/10.1097/MOU.0b013e32802b70bc
Omental metastasis with malignant ascites: an unusual manifestation of prostatic adenocarcinoma
Sanjeev Madaan, Victor Palit, Patricia Gudgeon and Chandra Shekhar Biyani 2007. Omental metastasis with malignant ascites: an unusual manifestation of prostatic adenocarcinoma. Canadian Urological Association Journal. 1 (3). https://doi.org/10.5489/cuaj.86
Ureteric complications of renal transplantation: the impact of the double J stent and the anterior extravesical ureteroneocystostomy
S. Guleria, R .Chahal, S. Madaan, H. C. Irving, C. G. Newstead, S. G. Pollard and J. P .A. Lodge 2005. Ureteric complications of renal transplantation: the impact of the double J stent and the anterior extravesical ureteroneocystostomy. Transplantation Proceedings. 37 (2), pp. 1054-1056. https://doi.org/10.1016/j.transproceed.2004.12.123
A complex caliceal-cutaneous and caliceal-peritoneal fistula in a renal transplant patient: a case for conservative management
Rohit Chahal, Sanjeev Madaan, Sandeep Guleria, J Peter A Lodge and John A Spencer 2004. A complex caliceal-cutaneous and caliceal-peritoneal fistula in a renal transplant patient: a case for conservative management. International Urology and Nephrology. 36, pp. 245-247. https://doi.org/10.1023/b:urol.0000034654.26422.f7
Transplant renal artery kinking: a rare cause of early graft dysfunction
Mohiuddin Miah, Sanjeev Madaan, David J Kessel, Charles G Newstead and Sandeep Guleria 2004. Transplant renal artery kinking: a rare cause of early graft dysfunction. Nephrology Dialysis Transplantation. 19 (7). https://doi.org/10.1093/ndt/gfh152
5-years outcome of a prospective randomised trial to compare Transurethral Electrovaporization of the Prostate (TUVP) to Standard Transurethral Resection (TURP)
Mohamed Y. Hammadeh, Sanjeev Madaan, John Hines and Timothy Philp 2003. 5-years outcome of a prospective randomised trial to compare Transurethral Electrovaporization of the Prostate (TUVP) to Standard Transurethral Resection (TURP). Urology. 61 (6), pp. 1166-1171. https://doi.org/10.1016/S0090-4295(03)00109-2
Androgen-dependent regulation of human MUC1 mucin expression
Stephen Mitchell, Paul Abel, Sanjeev Madaan, James Jeffs, Khurram Chaudhary, Gordon Stamp and El-Nasir Lalani 2002. Androgen-dependent regulation of human MUC1 mucin expression. Neoplasia. 4 (1), pp. 9-18. https://doi.org/10.1038/sj.neo.7900194
Cyclooxygenase-2: a possible target in schistosoma-associated bladder cancer
S.S. El-Sheikh, S. Madaan, A. Alhasso, P. Abel, G. Stamp and E.-N. Lalani 2002. Cyclooxygenase-2: a possible target in schistosoma-associated bladder cancer. BJU International. 88 (9), pp. 921-927. https://doi.org/10.1046/j.1464-4096.2001.01649.x
Genitourinary neurofibromatosis with prostatic involvement
Madaan, S., Hammadeh, S., Thomas, K., Philp, T. and Singh, M. 2001. Genitourinary neurofibromatosis with prostatic involvement. BJU International. 87 (903).
Cytoplasmic induction and over-expression of cyclooxygenase-2 in human prostate cancer: implications for prevention and treatment
S. Madaan, P.D. Abel, K.S. Chaudhary, R. Hewitt, M.A. Stott, G.W.H. Stamp and E.-N. Lalani 2001. Cytoplasmic induction and over-expression of cyclooxygenase-2 in human prostate cancer: implications for prevention and treatment. BJU International. 86 (6), pp. 736-741. https://doi.org/1046/j.1464-410x.2000.00867.x
A 3-year follow-up of a prospective randomized trial comparing transurethral electrovaporization of the prostate with standard transurethral prostatectomy
Hammadeh, M. Y., Madaan, S., Singh, M. and Philp. T. 2001. A 3-year follow-up of a prospective randomized trial comparing transurethral electrovaporization of the prostate with standard transurethral prostatectomy. BJU International. 86 (6), pp. 648-651. https://doi.org/10.1046/j.1464-410x.2000.00879.x
Cyclooxygenase-2 in prostate cancer
Madaan, S., Lalani, E-N. and Abel, P. D. 2000. Cyclooxygenase-2 in prostate cancer. Relias Media.
Urethral metastasis from a rectal adenocarcinoma
Madaan, S., Vohra, A. K., Riaz, A. A., Thomas, K. and Philp, T. 2000. Urethral metastasis from a rectal adenocarcinoma. BJU International. 86 (403).
Restorative proctocolectomy for collagenous colitis
Riaz, A. A,, Stirling, R. W., Madaan, S. and Dawson, P. M. 2000. Restorative proctocolectomy for collagenous colitis. Journal of the Royal Society of Medicine. 93 (5), pp. 261-261. https://doi.org/10.1177/014107680009300513
Two-year follow-up of a prospective randomised trial of electrovaporization versus resection of prostate
Hammadeh, M. Y., Madaan, S., Singh, M. and Philp, T. 1998. Two-year follow-up of a prospective randomised trial of electrovaporization versus resection of prostate. European Urology. 34 (3). https://doi.org/10.1159/000019710