Screening and active surveillance in prostate cancer: prognostic and short-term outcomes of active surveillance and quality of life aspects
Year: 2014
Type: dissertation
Abstract: Active surveillance (AS) has emerged as an alternative management option to that of immediate radical treatments of potentially overdiagnosed prostate cancers (PC). The aim of AS is to avoid or at least delay the side effects of immediate treatments. The objective of this study was to evaluate the feasibility of AS as a management option for low-risk PC and determine how AS affects the quality of life (QOL) of low-risk PC patients. The more specific aims of the present study were to evaluate the short-term outcomes of the prospective AS cohort, analyse the effects of AS on the QOL during screening and AS overall, assess the respective roles of diffusion-weighted magnetic resonance imaging (DW-MRI) and a free/total PSA ratio as diagnostic and prognostic tools in AS. The PRIAS (Prostate cancer Research International: Active Surveillance) study is an international prospective AS trial that originates from the European Randomized Study of Screening for Prostate Cancer (ERSPC). ERSPC is a multicenter, population-based and randomized screening trial that is being conducted in eight European countries. In this study outcomes of the 500 first PRIAS patients were analysed, the main outcome parameter was active treatment-free survival. Secondary endpoints included reasons for discontinuing AS, findings in the standard 1-year rebiopsies, and outcomes after radical prostatectomy. For the health-related quality of life (HRQL) analyses, the Finnish version of the RAND 36-Item Health Survey was used in both QOL studies. PRIAS participants also received IPSS and IIEF-5 questionnaires to analyse possible voiding symptoms and erectile function. RAND-36 QOL questionnaires were delivered to a total of more than 2000 screening participants of the Finnish arm of the ERSPC trial in five phases of the first screening round. 80 men who had enrolled in the Finnish arm of the PRIAS study underwent DW-MRI before standard 1-year rebiopsy. The global PRIAS study cohort was used with the initial free PSA value available in 939 patients to assess the role of free/total PSA ratio (%fPSA) as a prognostic tool in AS. AS is a feasible management option for patients with low-risk PC. Short-term analyses revealed that a quarter of men discontinue AS, mainly because of reclassification of PC in standard rebiopsy, which highlights the importance of accurate diagnostics. AS did not provoke major short-term QOL changes as assessed by standardized questionnaires and none of the patients on AS discontinued due to anxiety or distress. The HRQL of study patients was even better than that for the general age-stratified Finnish male population. Moreover, the PC screening did not have substantial effects on the short-term QOL of participants. DW-MRI, as interpreted in a routine clinical setting and performed in this study, could not predict treatment change or adverse rebiopsy or radical prostatectomy findings. PCs were small and rather well-differentiated, making it challenging to visualize these tumours using MRI. Free/total PSA ratio (%fPSA) at diagnosis could not predict outcomes of AS, although median %fPSA values were significantly lower in patients with treatment change. However, change of %fPSA over time may have a value as a prognostic tool in AS.
Source: Työväentutkimus Vuosikirja
Author: Hanna Vasarainen
Language: English
Subfield: Urology
Field: Medicine
Domain: Health Sciences
Open Access status: green
OpenAlex ID: W1510761060