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Journals / Yeni Üroloji Dergisi / 2026 / Volume: 18 Issue: 1

At what stage are we in active surveillance for localized prostate cancer? Our clinical experience

Lokalize prostat kanseri için aktif izlemde hangi aşamadayız? Klinik deneyimimiz

İsmail Evren(UNIVERSITY OF HEALTH SCIENCES, İSTANBUL BAKIRKÖY DR. SADİ KONUK TRAINING RESEARCH CENTER)0000-0003-4008-8038
Yavuz Danacıoğlu(UNIVERSITY OF HEALTH SCIENCES, İSTANBUL BAKIRKÖY DR. SADİ KONUK TRAINING RESEARCH CENTER)0000-0002-3170-062X
Mithat Ekşi(UNIVERSITY OF HEALTH SCIENCES, İSTANBUL BAKIRKÖY DR. SADİ KONUK TRAINING RESEARCH CENTER)0000-0003-1490-3756
Deniz Noyan Özlü(İSTANBUL BAKIRKÖY DR. SADİ KONUK TRAINING RESEARCH CENTER)0000-0003-2435-5482
Ahmet Haciislamoğlu(UNIVERSITY OF HEALTH SCIENCES, İSTANBUL BAKIRKÖY DR. SADİ KONUK TRAINING RESEARCH CENTER)0000-0002-6117-2098
Yusuf Arıkan(UNIVERSITY OF HEALTH SCIENCES, İSTANBUL BAKIRKÖY DR. SADİ KONUK TRAINING RESEARCH CENTER)0000-0003-0823-7400
Hakan Polat(UNIVERSITY OF HEALTH SCIENCES, İSTANBUL BAKIRKÖY DR. SADİ KONUK TRAINING RESEARCH CENTER)0000-0003-1525-1243
Pages
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Publication Date
2023-02-27
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AI Summary & Key Takeaways

AI Insight
⚡ TL;DR(Too Long; Didn't Read)

However, it should not be forgotten that pathological upgrades may occur in 30% of AS patients, indicating the need for definitive treatment.

📌 3 Key Takeaways

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Objective & Hypothesis:Objective: Prostate cancer (PCa) is the most common malignancy in men and early diagnosis can be made by screening.
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Key Findings & Data:Material and Methods: Data from 1650 patients who were diagnosed with PCa in the period between January 2014 and December 2019, were retrospectively reviewed.
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Conclusion & Impact:However, it should not be forgotten that pathological upgrades may occur in 30% of AS patients, indicating the need for definitive treatment.
🔬Design:Review & Systematic Survey
📍Scope:2014 Verileri
⚙️Variables:Prostate cancer · Active surveillance · Low-risk prostate cancer

Abstract

Objective: Prostate cancer (PCa) is the most common malignancy in men and early diagnosis can be made by screening. Active surveillance (AS) is one of the options for disease management in patients with low-risk prostate cancer (LRPC). In this study, we aimed to evaluate our clinical experience in AS for prostate cancer. Material and Methods: Data from 1650 patients who were diagnosed with PCa in the period between January 2014 and December 2019, were retrospectively reviewed. Inclusion criteria were defined as being under 75 years of age and having a 10-year life expectancy, being at clinical stages of T1-T2a, having a PSA level of <10 ng/dl, having positive biopsy cores of ≤2, and having a Gleason score of ≤6 as the result of the pathological examination of the biopsy specimen. Patients not meeting any of the inclusion criteria were excluded from the study. Results: After the inclusion and exclusion criteria, 176 patients agreed to undergo AS and were included in the study. The mean follow-up duration was 25.2 ± 13 months. A total of 57 patients (32.3%) left the AS program to undergo definitive treatment. Definitive treatment was radical prostatectomy in 38 (65.5%) patients, radiotherapy in 18 (31%) patients, and hormonotherapy in one (1.7%) patient. Conclusion: AS is a method that helps avoid the complications of definitive treatment in LRPC patients. It can be used as an alternative option to definitive treatment in the management of these patients. However, it should not be forgotten that pathological upgrades may occur in 30% of AS patients, indicating the need for definitive treatment.

Özet

Amaç: Prostat kanseri (PCa) erkeklerde en sık görülen bir malignitedir ve taramayla erken tanı konulabilir. Aktif izlem (Aİ), düşük riskli prostat kanserli (DRPK) hastalarda tedavi yönetimi seçeneklerinden biridir. Bu çalışmada prostat kanserinde Aİ ile ilgili klinik deneyimimizi değerlendirmeyi amaçladık. Gereç ve Yöntemler: Ocak 2014 ile Aralık 2019 tarihleri ​​arasında PCa tanısı konan 1650 hastanın verileri retrospektif olarak incelendi. Dahil edilme kriterleri; 75 yaş altı olma ve 10 yıllık yaşam beklentisi mevcudiyeti, klinik T1-T2a evre, PSA düzeyi <10 ng/dl, biyopsi kor ≤2 pozitif olmak ve biyopsi örneğinin patolojik incelemesinin sonucu olarak Gleason skoru ≤6 olunması olarak tanımlandı. Dahil edilme kriterlerinden herhangi birini karşılamayan hastalar çalışma dışı bırakıldı. Bulgular: Dahil etme ve hariç tutma kriterlerinden sonra 176 hasta Aİ’i kabul etti ve çalışmaya dahil edildi. Ortalama takip süresi 25,2 ± 13 aydı. Toplam 57 hasta (32,3%) kesin tedavi için Aİ programından ayrıldı. Kesin tedavi 38 (65,5%) hastada radikal prostatektomi, 18 (31%) hastada radyoterapi ve bir (1,7%) hastada hormonoterapi idi. Sonuç: Aİ, DRPK hastalarında kesin tedavinin komplikasyonlarını önlemeye yardımcı olan bir yöntemdir. Bu hastalarının yönetiminde kesin tedaviye alternatif bir seçenek olarak kullanılabilir. Ancak Aİ hastalarının 30%’unda definitif tedavi ihtiyacı doğuran patolojik upgrade’ler olabileceği unutulmamalıdır.

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Cite This Article

Evren, İ., Danacıoğlu, Y., Ekşi, M., Özlü, D. N., Haciislamoğlu, A., Arıkan, Y., Polat, H. (2023). At what stage are we in active surveillance for localized prostate cancer? Our clinical experience. Yeni Üroloji Dergisi, Volume: 18 Issue: 1. https://doi.org/10.33719/yud.2023;18-1-1129666

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References (35)

  1. Siegel R, Ma J, Zou Z, Jemal A. Cancer statistics, 2014. CA Cancer J Clin. 2014;64(1):9-29. https://doi:10.3322/caac.21208
  2. Wong MC, Goggins WB, Wang HH, et al. Global Incidence and Mortality for Prostate Cancer: Analysis of Temporal Patterns and Trends in 36 Countries. Eur Urol. 2016;70(5):862-874. https://doi:10.1016/j.eururo.2016.05.043
  3. Network NCI. Cancer incidence, males, ICD10 C61: Prostate, 2008-2010. National Cancer Intelligence Network (NCIN), UK Cancer Information Service (UKCIS). UKCIS. 2010.
  4. Van Hemelrijck M, Garmo H, Wigertz A, Nilsson P, Stattin P. Cohort Profile Update: The National Prostate Cancer Register of Sweden and Prostate Cancer data Base--a refined prostate cancer trajectory. Int J Epidemiol. 2016;45(1):73-82. https://doi:10.1093/ije/dyv305
  5. Cooperberg MR, Carroll PR. Trends in Management for Patients With Localized Prostate Cancer, 1990-2013. JAMA. 2015;314(1):80-82. https://doi:10.1001/jama.2015.6036
  6. Tosoian JJ, Carter HB, Lepor A, Loeb S. Active surveillance for prostate cancer: current evidence and contemporary state of practice. Nat Rev Urol. 2016;13(4):205-215. https://doi:10.1038/nrurol.2016.45
  7. Tseng KS, Landis P, Epstein JI, Trock BJ, Carter HB. Risk stratification of men choosing surveillance for low risk prostate cancer. J Urol. 2010;183(5):1779-1785. https://doi:10.1016/j.juro.2010.01.001
  8. Selvadurai ED, Singhera M, Thomas K, et al. Medium-term outcomes of active surveillance for localised prostate cancer. Eur Urol. 2013;64(6):981-987. https://doi:10.1016/j.eururo.2013.02.020
  9. Dall'Era MA, Albertsen PC, Bangma C, et al. Active surveillance for prostate cancer: a systematic review of the literature. Eur Urol. 2012;62(6):976-983. https://doi:10.1016/j.eururo.2012.05.072.
  10. Villers A, Puech P, Mouton D, Leroy X, Ballereau C, Lemaitre L. Dynamic contrast enhanced, pelvic phased array magnetic resonance imaging of localized prostate cancer for predicting tumor volume: correlation with radical prostatectomy findings. J Urol. 2006;176(6 Pt 1):2432-2437. https://doi:10.1016/j.juro.2006.08.007
  11. Somford DM, Hoeks CM, Hulsbergen-van de Kaa CA, et al; MR-PRIAS Collaboration Group. Evaluation of diffusion-weighted MR imaging at inclusion in an active surveillance protocol for low-risk prostate cancer. Invest Radiol. 2013;48(3):152-157. https://doi:10.1097/RLI.0b013e31827b711e
  12. Mitsuzuka K, Koga H, Sugimoto M, et al. Current use of active surveillance for localized prostate cancer: A nationwide survey in Japan. Int J Urol. 2015;22(8):754-759. https://doi:10.1111/iju.12813
  13. Huland H, Graefen M. Changing Trends in Surgical Management of Prostate Cancer: The End of Overtreatment? Eur Urol. 2015;68(2):175-178. https://doi:10.1016/j.eururo.2015.02.020.
  14. Epstein JI, Feng Z, Trock BJ, Pierorazio PM. Upgrading and downgrading of prostate cancer from biopsy to radical prostatectomy: incidence and predictive factors using the modified Gleason grading system and factoring in tertiary grades. Eur Urol. 2012;61(5):1019-1024. https://doi:10.1016/j.eururo.2012.01.050.
  15. Tosoian JJ, Mamawala M, Epstein JI, et al. Intermediate and Longer-Term Outcomes From a Prospective Active-Surveillance Program for Favorable-Risk Prostate Cancer. J Clin Oncol. 2015;33(30):3379-3385. https://doi:10.1200/JCO.2015.62.5764
  16. Tosoian JJ, Mamawala M, Epstein JI, et al. Intermediate and Longer-Term Outcomes From a Prospective Active-Surveillance Program for Favorable-Risk Prostate Cancer. J Clin Oncol. 2015;33(30):3379-3385. https://doi:10.1200/JCO.2015.62.5764
  17. Godtman RA, Holmberg E, Khatami A, Stranne J, Hugosson J. Outcome following active surveillance of men with screen-detected prostate cancer. Results from the Göteborg randomised population-based prostate cancer screening trial. Eur Urol. 2013;63(1):101-107. https://doi:10.1016/j.eururo.2012.08.066
  18. Welty CJ, Cowan JE, Nguyen H, et al. Extended followup and risk factors for disease reclassification in a large active surveillance cohort for localized prostate cancer. J Urol. 2015;193(3):807-811. https://doi:10.1016/j.juro.2014.09.094
  19. Selvadurai ED, Singhera M, Thomas K, et al. Medium-term outcomes of active surveillance for localised prostate cancer. Eur Urol. 2013;64(6):981-987. https://doi:10.1016/j.eururo.2013.02.020
  20. Thompson JE, Hayen A, Landau A, et al. Medium-term oncological outcomes for extended vs saturation biopsy and transrectal vs transperineal biopsy in active surveillance for prostate cancer. BJU Int. 2015;115(6):884-891. https://doi:10.1111/bju.12858
  21. Bul M, Zhu X, Valdagni R, et al. Active surveillance for low-risk prostate cancer worldwide: the PRIAS study. Eur Urol. 2013;63(4):597-603. https://doi:10.1016/j.eururo.2012.11.005
  22. Thomsen FB, Røder MA, Hvarness H, Iversen P, Brasso K. Active surveillance can reduce overtreatment in patients with low-risk prostate cancer. Dan Med J. https://2013;60(2):A4575.
  23. Soloway MS, Soloway CT, Eldefrawy A, Acosta K, Kava B, Manoharan M. Careful selection and close monitoring of low-risk prostate cancer patients on active surveillance minimizes the need for treatment. Eur Urol. 2010;58(6):831-835. https://doi:10.1016/j.eururo.2010.08.027
  24. Clinically Localized Prostate Cancer: AUA/ASTRO/SUO Guideline (2017)
  25. EAU - EANM - ESTRO - ESUR - SIOG Guidelines on Prostate Cancer 2020. Section 6.2.1.1.1 Active surveillance – inclusion criteria p64.
  26. Davison BJ, Oliffe JL, Pickles T, Mroz L. Factors influencing men undertaking active surveillance for the management of low-risk prostate cancer. Oncol Nurs Forum. 2009;36(1):89-96. https://doi:10.1188/09.ONF.89-96
  27. Gorin MA, Soloway CT, Eldefrawy A, Soloway MS. Factors that influence patient enrollment in active surveillance for low-risk prostate cancer. Urology. 2011;77(3):588-591. https://doi:10.1016/j.urology.2010.10.039
  28. Volk RJ, McFall SL, Cantor SB, et al. 'It's not like you just had a heart attack': decision-making about active surveillance by men with localized prostate cancer. Psychooncology. 2014;23(4):467-472. https://doi:10.1002/pon.3444
  29. Anandadas CN, Clarke NW, Davidson SE, et al. Early prostate cancer--which treatment do men prefer and why?. BJU Int. 2011;107(11):1762-1768. https://doi:10.1111/j.1464-410X.2010.09833.x
  30. van den Bergh RC, Korfage IJ, Bangma CH. Psychological aspects of active surveillance. Curr Opin Urol. 2012;22(3):237-242. https://doi:10.1097/MOU.0b013e328351dcb1
  31. van den Bergh RC, van Vugt HA, Korfage IJ, et al. Disease insight and treatment perception of men on active surveillance for early prostate cancer. BJU Int. 2010;105(3):322-328. https://doi:10.1111/j.1464-410X.2009.08764.x
  32. Xu J, Dailey RK, Eggly S, Neale AV, Schwartz KL. Men's perspectives on selecting their prostate cancer treatment. J Natl Med Assoc. 2011;103(6):468-478. https://doi:10.1016/s0027-9684(15)30359-x
  33. Duffield AS, Lee TK, Miyamoto H, Carter HB, Epstein JI. Radical prostatectomy findings in patients in whom active surveillance of prostate cancer fails. J Urol. 2009;182(5):2274-2278. https://doi:10.1016/j.juro.2009.07.024
  34. Soloway MS, Soloway CT, Eldefrawy A, Acosta K, Kava B, Manoharan M. Careful selection and close monitoring of low-risk prostate cancer patients on active surveillance minimizes the need for treatment. Eur Urol. 2010;58(6):831-835. https://doi:10.1016/j.eururo.2010.08.027
  35. Bul M, Zhu X, Rannikko A, et al. Radical prostatectomy for low-risk prostate cancer following initial active surveillance: results from a prospective observational study. Eur Urol. 2012;62(2):195-200. https://doi:10.1016/j.eururo.2012.02.002