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Using prognosis to ...
Using prognosis to guide inclusion criteria, define standardised endpoints and stratify follow-up in active surveillance for prostate cancer
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- Gnanapragasam, V. J. (author)
- 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
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- Barrett, T. (author)
- Univ Cambridge, Dept Radiol, Cambridge, England
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- Thankapannair, V. (author)
- Cambridge Univ Hosp NHS Trust, Dept Urol, Cambridge, England
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- Thurtle, D. (author)
- Univ Cambridge, Acad Urol Grp, Dept Surg, Box 279 S4,Cambridge Biomed Campus, Cambridge CB2 0QQ, England
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- Rubio-Briones, J. (author)
- Fdn Inst Valenciano Oncol, Valencia, Spain
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- Domínguez-Escrig, J. (author)
- Fdn Inst Valenciano Oncol, Valencia, Spain
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- Bratt, Ola, 1963 (author)
- Gothenburg University,Göteborgs universitet,Institutionen för kliniska vetenskaper,Institute of Clinical Sciences,Gothenburg Univ, Sahlgrenska Acad, Gothenburg, Sweden
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- Stattin, Pär (author)
- Uppsala universitet,Urologkirurgi
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- Muir, K. (author)
- Univ Manchester, Dept Publ Hlth & Epidemiol, Manchester, Lancs, England
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- Lophatananon, A. (author)
- Univ Manchester, Dept Publ Hlth & Epidemiol, Manchester, Lancs, England
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(creator_code:org_t)
- 2019-06-02
- 2019
- English.
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In: Bju International. - : Wiley. - 1464-4096 .- 1464-410X. ; 124:5, s. 758-767
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Abstract
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- 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=27942) 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 3.5years) only 6% (eight of 133) progressed to CPG3. Predictors of progression were a PSA density ≥0.15ng/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. © 2019 The Authors. BJU International © 2019 BJU International Published by John Wiley & Sons Ltd
Subject headings
- MEDICIN OCH HÄLSOVETENSKAP -- Klinisk medicin -- Urologi och njurmedicin (hsv//swe)
- MEDICAL AND HEALTH SCIENCES -- Clinical Medicine -- Urology and Nephrology (hsv//eng)
- MEDICIN OCH HÄLSOVETENSKAP -- Klinisk medicin -- Cancer och onkologi (hsv//swe)
- MEDICAL AND HEALTH SCIENCES -- Clinical Medicine -- Cancer and Oncology (hsv//eng)
Keyword
- #PCSM
- #ProstateCancer
- Active surveillance
- Cambridge Prognostic Groups
- Intermediate-risk
- Localised prostate cancer
- Low-risk
- Stratified follow-up
- Localised prostate cancer
Publication and Content Type
- ref (subject category)
- art (subject category)
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Gnanapragasam, V ...
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Barrett, T.
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Thankapannair, V ...
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Thurtle, D.
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Rubio-Briones, J ...
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Domínguez-Escrig ...
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show more...
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Bratt, Ola, 1963
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Stattin, Pär
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Muir, K.
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Lophatananon, A.
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show less...
- About the subject
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- MEDICAL AND HEALTH SCIENCES
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and Clinical Medicin ...
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University of Gothenburg
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Uppsala University