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Clinical and pathologic factors predicting reclassification in active surveillance cohorts
Sierra, Pablo S; Damodaran, Shivashankar; Jarrard, David.
  • Sierra, Pablo S; Universidad Icesi. Fundacion Valle del Lili. Cali. CO
  • Damodaran, Shivashankar; University of Wisconsin School of Medicine and Public Health. Department of Urology. Madison. US
  • Jarrard, David; University of Wisconsin School of Medicine and Public Health. Department of Urology. Madison. US
Int. braz. j. urol ; 44(3): 440-451, May-June 2018. tab
Artículo en Inglés | LILACS | ID: biblio-954060
ABSTRACT
ABSTRACT The incidence of small, lower risk well-differentiated prostate cancer is increasing and almost half of the patients with this diagnosis are candidates for initial conservative management in an attempt to avoid overtreatment and morbidity associated with surgery or radiation. A proportion of patients labeled as low risk, candidates for Active Surveillance (AS), harbor aggressive disease and would benefit from definitive treatment. The focus of this review is to identify clinicopathologic features that may help identify these less optimal AS candidates. A systematic Medline/PubMed Review was performed in January 2017 according to PRISMA guidelines; 83 articles were selected for full text review according to their relevance and after applying limits described. For patients meeting AS criteria including Gleason Score 6, several factors can assist in predicting those patients that are at higher risk for reclassification including higher PSA density, bilateral cancer, African American race, small prostate volume and low testosterone. Nomograms combining these features improve risk stratification. Clinical and pathologic features provide a significant amount of information for risk stratification (>70%) for patients considering active surveillance. Higher risk patient subgroups can benefit from further evaluation or consideration of treatment. Recommendations will continue to evolve as data from longer term AS cohorts matures.
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Texto completo: Disponible Índice: LILACS (Américas) Asunto principal: Neoplasias de la Próstata / Medición de Riesgo / Espera Vigilante Tipo de estudio: Estudio diagnóstico / Estudio de etiología / Guía de Práctica Clínica / Estudio pronóstico / Factores de riesgo / Estudio de tamizaje Límite: Humanos / Masculino Idioma: Inglés Revista: Int. braz. j. urol Asunto de la revista: Urología Año: 2018 Tipo del documento: Artículo País de afiliación: Colombia / Estados Unidos Institución/País de afiliación: Universidad Icesi/CO / University of Wisconsin School of Medicine and Public Health/US

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Texto completo: Disponible Índice: LILACS (Américas) Asunto principal: Neoplasias de la Próstata / Medición de Riesgo / Espera Vigilante Tipo de estudio: Estudio diagnóstico / Estudio de etiología / Guía de Práctica Clínica / Estudio pronóstico / Factores de riesgo / Estudio de tamizaje Límite: Humanos / Masculino Idioma: Inglés Revista: Int. braz. j. urol Asunto de la revista: Urología Año: 2018 Tipo del documento: Artículo País de afiliación: Colombia / Estados Unidos Institución/País de afiliación: Universidad Icesi/CO / University of Wisconsin School of Medicine and Public Health/US