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Using prognosis to guide inclusion criteria, define standardised endpoints and stratify follow-up in active surveillance for prostate cancer
Univ Cambridge, Acad Urol Grp, Dept Surg, Box 279 S4,Cambridge Biomed Campus, Cambridge CB2 0QQ, England;Cambridge Univ Hosp NHS Trust, Dept Urol, Cambridge, England;Univ Cambridge, Cambridge Urol Translat Res & Clin Trials, Cambridge Biomed Campus, Cambridge, England.
Univ Cambridge, Dept Radiol, Cambridge, England.
Cambridge Univ Hosp NHS Trust, Dept Urol, Cambridge, England.
Univ Cambridge, Acad Urol Grp, Dept Surg, Box 279 S4,Cambridge Biomed Campus, Cambridge CB2 0QQ, England.ORCID iD: 0000-0001-5636-7088
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2019 (English)In: BJU International, ISSN 1464-4096, E-ISSN 1464-410X, Vol. 124, no 5, p. 758-767Article in journal (Refereed) Published
Abstract [en]

Objectives To test whether using disease prognosis can inform a rational approach to active surveillance (AS) for early prostate cancer. Patients and methods We previously developed the Cambridge Prognostics Groups (CPG) classification, a five-tiered model that uses prostate-specific antigen (PSA), Grade Group and Stage to predict cancer survival outcomes. We applied the CPG model to a UK and a Swedish prostate cancer cohort to test differences in prostate cancer mortality (PCM) in men managed conservatively or by upfront treatment in CPG2 and 3 (which subdivides the intermediate-risk classification) vs CPG1 (low-risk). We then applied the CPG model to a contemporary UK AS cohort, which was optimally characterised at baseline for disease burden, to identify predictors of true prognostic progression. Results were re-tested in an external AS cohort from Spain. Results In a UK cohort (n = 3659) the 10-year PCM was 2.3% in CPG1, 1.5%/3.5% in treated/untreated CPG2, and 1.9%/8.6% in treated/untreated CPG3. In the Swedish cohort (n = 27 942) the10-year PCM was 1.0% in CPG1, 2.2%/2.7% in treated/untreated CPG2, and 6.1%/12.5% in treated/untreated CPG3. We then tested using progression to CPG3 as a hard endpoint in a modern AS cohort (n = 133). During follow-up (median 3.5 years) only 6% (eight of 133) progressed to CPG3. Predictors of progression were a PSA density >= 0.15 ng/mL/mL and CPG2 at diagnosis. Progression occurred in 1%, 8% and 21% of men with neither factor, only one, or both, respectively. In an independent Spanish AS cohort (n = 143) the corresponding rates were 3%, 10% and 14%, respectively. Conclusion Using disease prognosis allows a rational approach to inclusion criteria, discontinuation triggers and risk-stratified management in AS.

Place, publisher, year, edition, pages
WILEY , 2019. Vol. 124, no 5, p. 758-767
Keywords [en]
Localised prostate cancer, Low-risk, Intermediate-risk, Active surveillance, Cambridge Prognostic Groups, Stratified follow-up, #ProstateCancer, #PCSM
National Category
Urology and Nephrology
Identifiers
URN: urn:nbn:se:uu:diva-397038DOI: 10.1111/bju.14800ISI: 000491957100010PubMedID: 31063245OAI: oai:DiVA.org:uu-397038DiVA, id: diva2:1371735
Available from: 2019-11-20 Created: 2019-11-20 Last updated: 2019-11-20Bibliographically approved

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