Active Surveillance is acceptable for for high-risk


Congestive heart failure, diabetes with end organ dysfunction. • Charlson co-morbidity index. This man was treated with combination XRT/brachy, and Androgen ...

SURE:  Active Surveillance is  acceptable for for high‐risk  prostate cancer  (be nuanced) Viraj Master MD PhD FACS Professor Department of Urology Emory University

What is high risk prostate cancer,  really? • We are still using a definition (essentially)  unchanged since 1999 • A. V. D’Amico • Used end point of PSA failure (really, is  this worthwhile?) • Clinical T stage ≥cT2c  • Gleason score ≥8,  • PSA >20 ng/ml  • Still the AUA definition

Common definitions of high‐risk  prostate cancer

Other definitions of high risk • RTOG – – – –

Gleason score ≥8  or Gleason score 7 plus either ≥cT3  or node‐positive disease;  PSA adds little to this model for the prediction of cause‐ specific survival or overall survival 

• NCCN – – – –

T3a  Gleason ≥8  PSA ≥20 ng/ml  ‘very high risk’ as T3b or T4 disease 

Not all patients with prostate cancer  produce the same level of PSA • ~350 patient study of Black and White men • Benign prostate tissue produces equal  amounts of PSA in Black and White men • BUT, Gleason score 3+3=6 (Grade Group 1)  prostate cancer produces less PSA in Black  men

Case • • • •

66 yo man no comorbid conditions PSA 22 GG 3+4 = 7 cT1c (no palpable disease)

Case…nuances • • • •

66 yo man no comorbid conditions PSA 22 GG 3+4 = 7 cT1c (no palpable disease)

• 150gm prostate • PSA in 2011 was 23

Case…nuances • 66 yo man no comorbid  • 7 previous negative  conditions biopsies (2000‐2015) • PSA 22 • GG 7 disease found   • GG 3+4 = 7 • cT1c (no palpable  disease) • 150gm prostate • PSA in 2011 was 23

Sorting out the bad actors

Case 2 • 70 yo • PSA 9.4, cT1c, Gleason 8 • Congestive heart failure, diabetes with end organ  dysfunction • Charlson co‐morbidity index

This man was treated with combination XRT/brachy,  and Androgen deprivation therapy

Conclusion of the Case • Patient has intractable hematuria 2 years after  therapy.  • Multiple hospitalizations • Transfusions • Died of bleeding‐related complications 

Emory-Harvard-University of Washington Prostate Cancer Biomarker Center (an EDRN CVC) AIM 2b



Elevated PSA or Suspicious DRE

A

Primary/ Local Treatment

Urine

AIM 1: Combine  serum phi with  urine PCA3/T2Erg

Diagnostic/ Index Prostate Biopsy

Definitive Treatment

C Regional/Systemic Therapy

B Active Surveillance

AIM 3

AIM 2a PET Imaging Biopsy Tissue

HYPOTHESIS: early detection targeting aggressive prostate cancer, will enhance survival benefit of treating lethal disease yet reduce harms of over-treating indolent Pca AIMS: • • •

Validate combining phi, PCA3, T2Erg to predict biopsy (PCA3 Trial) and AS progression-PASS Validate multiplex RNA signatures (tissue, urine) to discern aggressive PCa (PASS, URS) FACBC-PET to detect occult metastatic in high risk primary prostate cancer

INVESTIGATORS: Emory: Sanda (PI), Huang (co-PI), Moreno, Schuster, Goodman, Alemozaffar, Petros, Pellegrini; Harvard SPH: Mucci; Univ Washington: Lin (PASS)

Conclusions The literature is limited: consequence of variations in definition  lack of prospective randomized trials limitations in statistical plan (underpowered  studies)  • the need for long‐term follow‐up,  • suboptimal end points  • Treating the entire patient • • • •

Recommend Documents
PROSTATE CANCER PDF калі ласка націсніце на спасылку вышэй. Get Read & Download Ebook active surveillance for localized prostate cancer as PDF for ...

Our Library Available Get Read & Download Ebook active surveillance for localized prostate cancer as PDF for free ebook library in the world. Get active ...

ACCEPTABLE FOOTWEAR FOR SOCCER. The acceptable footwear for soccer will be a turf shoe. Turf shoes may be worn during practices and games.

5 Be authorized to monitor or examine all system activities, including ... user of the District's system, or any of the agencies or other networks that are connected .... In consideration for my child using the District's electronic communications.

Active Postmarketing Drug Surveillance for Multiple. Adverse Events. Joel Goh. Stanford Graduate School of Business, CA 94305, [email protected]

Aug 1, 2012 - Abbreviations. PSA, prostate-specific antigen; ERSPC, European Rando- mized Trial of Screening for Prostate Cancer; PCPT,. Prostate Cancer Prevention Trial; MRI, magnetic reso- nance imaging. Competing interest. The author declares that

Email &. Internet. Searches. Current. Internet. PEDs. Taking. Action. Against. PED. Websites .... Conduct all business through encrypted emails. • Accept WU ... www.vpxsports.com/article-detail/drugs/pinnacle-labs-all-good-things. •Pinnacle ...

editor, Meaning and Method: Essays in Honor of Hilary Putnam. Harvard University Press,. Cambridge, MA. Reprinted in [Boolos, 1998]. [Boolos, 1998] Boolos ...

and that as students learn by example, all adults within school should act as positive role models with regard to their ... Communications Act 2003. ○ Sexual ...

I will monitor the use of all ICT in school and report any inappropriate use by pupils or ... I must not use social media tools to communicate with current or former.