Focal therapy in prostate cancer-report from a consensus panel. Individualized estimation of the benefit of radical prostatectomy from the Scandinavian Prostate Cancer Group randomized trial. Simultaneous integrated boost of biopsy proven, MRI defined dominant intra-prostatic lesions to 95 Gray with IMRT: early results of a phase I NCI study Focal therapy for localised unifocal and multifocal prostate cancer: a prospective development study Active surveillance for the management of prostate cancer in a contemporary cohort Radical prostatectomy versus watchful waiting in early prostate cancer. [CCAFU Recommendations 2013: Prostate cancer]. Medium-term outcomes of active surveillance for localised prostate cancer. Dutasteride in localised prostate cancer management: the REDEEM randomised, double-blind, placebo-controlled trial Prostate cancer antigen 3 score accurately predicts tumour volume and might help in selecting prostate cancer patients for active surveillance. Survival associated with treatment vs observation of localized prostate cancer in elderly men. Prostate cancer: value of multiparametric MR imaging at 3 T for detection--histopathologic correlation. TOOKAD® Soluble vascular‐targeted photodynamic (VTP) therapy: determination of optimal treatment conditions and assessment of effects in patients with localised prostate cancer Urine TMPRSS2:ERG fusion transcript integrated with PCA3 score, genotyping, and biological features are correlated to the results of prostatic biopsies in men at risk of prostate cancer. The influence of finasteride on the development of prostate cancer. Clinical results of long-term follow-up of a large, active surveillance cohort with localized prostate cancer.
PURPOSE To establish a consensus in relation to case selection , conduct of therapy , and outcomes that are associated with focal therapy for men with localized prostate cancer . MATERIAL AND METHODS Urologic surgeons , radiation oncologists , radiologists , and histopathologists from North America and Europe participated in a consensus workshop on focal therapy for prostate cancer . The consensus process was face to face within a structured meeting , in which pertinent clinical issues were raised , discussed , and agreement sought . Where no agreement was possible , this was acknowledged , and the nature of the disagreement noted . RESULTS C and i date s for focal treatment should have unilateral low- to intermediate-risk disease with clinical stage < or = cT(2a ) . Prostate size and both tumor volume and tumor topography are important case selection criteria that depend on the ablative technology used . Currently , the best method to ascertain the key characteristics for men who are considering focal therapy is exposure to transperineal template mapping biopsies . MRI of the prostate using novel techniques such as dynamic contrast enhancement and diffusion weighed imaging are increasingly being used to diagnose and stage primary prostate cancer with excellent results . For general use , however , these new techniques require validation in prospect i ve clinical trials . Until such are performed , MRI will , in most centers , continue to be an investigative tool in assessing eligibility of patients for focal therapy . CONCLUSIONS Consensus was derived for most of the key aspects of case selection , conduct of treatment , and outcome measures for men who are undergoing focal therapy for localized prostate cancer . The level of agreement achieved will pave the way for future collaborative trials BACKGROUND Although there is r and omized evidence that radical prostatectomy improves survival , there are few data on how benefit varies by baseline risk . OBJECTIVE We aim ed to create a statistical model to calculate the decrease in risk of death associated with surgery for an individual patient , using stage , grade , prostate-specific antigen , and age as predictors . DESIGN , SETTING , AND PARTICIPANTS A total of 695 men with T1 or T2 prostate cancer participated in the Sc and inavian Prostate Cancer Group 4 trial ( SPCG-4 ) . INTERVENTION Patients in SPCG-4 were r and omized to radical prostatectomy or conservative management . OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS Competing risk models were created separately for the radical prostatectomy and the watchful waiting group , with the difference between model predictions constituting the estimated benefit for an individual patient . RESULTS AND LIMITATIONS Individualized predictions of surgery benefit varied widely depending on age and tumor characteristics . At 65 yr of age , the absolute 10-yr risk reduction in prostate cancer mortality attributable to radical prostatectomy ranged from 4.5 % to 17.2 % for low- versus high-risk patients . Little expected benefit was associated with surgery much beyond age 70 . Only about a quarter of men had an individualized benefit within even 50 % of the mean . A limitation is that estimates from SPCG-4 have to be applied cautiously to contemporary patients . CONCLUSIONS Our model suggests that it is hard to justify surgery in patients with Gleason 6 , T1 disease or in those patients much above 70 yr of age . Conversely , surgery seems unequivocally of benefit for patients who have Gleason 8 , or Gleason 7 , stage T2 . For patients with Gleason 6 T2 and Gleason 7 T1 , treatment is more of a judgment call , depending on patient preference and other clinical findings , such as the number of positive biopsy cores and comorbidities Background To assess the feasibility and early toxicity of selective , IMRT-based dose escalation ( simultaneous integrated boost ) to biopsy proven dominant intra-prostatic lesions visible on MRI . Methods Patients with localized prostate cancer and an abnormality within the prostate on endorectal coil MRI were eligible . All patients underwent a MRI-guided transrectal biopsy at the location of the MRI abnormality . Gold fiducial markers were also placed . Several days later patients underwent another MRI scan for fusion with the treatment planning CT scan . This fused MRI scan was used to delineate the region of the biopsy proven intra-prostatic lesion . A 3 mm expansion was performed on the intra-prostatic lesions , defined as a separate volume within the prostate . The lesion + 3 mm and the remainder of the prostate + 7 mm received 94.5/75.6 Gray ( Gy ) respectively in 42 fractions . Daily seed position was verified to be within 3 mm . Results Three patients were treated . Follow-up was 18 , 6 , and 3 months respectively . Two patients had a single intra-prostatic lesion . One patient had 2 intra-prostatic lesions . All four intra-prostatic lesions , with margin , were successfully targeted and treated to 94.5 Gy . Two patients experienced acute RTOG grade 2 genitourinary ( GU ) toxicity . One had grade 1 gastrointestinal ( GI ) toxicity . All symptoms completely resolved by 3 months . One patient had no acute toxicity . Conclusion These early results demonstrate the feasibility of using IMRT for simultaneous integrated boost to biopsy proven dominant intra-prostatic lesions visible on MRI . The treatment was well tolerated Summary Background Radical whole-gl and therapy can lead to significant genitourinary and rectal side-effects for men with localised prostate cancer . We report on whether selective focal ablation of unifocal and multifocal cancer lesions can reduce this treatment burden . Methods Men aged 45–80 years were eligible for this prospect i ve development study if they had low-risk to high-risk localised prostate cancer ( prostate specific antigen [ PSA ] ≤15 ng/mL , Gleason score ≤4 + 3 , stage ≤T2 ) , with no previous and rogen deprivation or treatment for prostate cancer , and who could safely undergo multiparametric MRI and have a general anaesthetic . Patients received focal therapy using high-intensity focused ultrasound , delivered to all known cancer lesions , with a margin of normal tissue , identified on multiparametric MRI , template prostate-mapping biopsies , or both . Primary endpoints were adverse events ( serious and otherwise ) and urinary symptoms and erectile function assessed using patient question naires . Analyses were done on a per- protocol basis . This study is registered with Clinical Trials.gov , number NCT00561314 . Findings 42 men were recruited between June 27 , 2007 , and June 30 , 2010 ; one man died from an unrelated cause ( pneumonia ) 3 months after treatment and was excluded from analyses . After treatment , one man was admitted to hospital for acute urinary retention , and another had stricture interventions requiring hospital admission . Nine men ( 22 % , 95 % CI 11–38 ) had self-resolving , mild to moderate , intermittent dysuria ( median duration 5·0 days [ IQR 2·5–18·5 ] ) . Urinary debris occurred in 14 men ( 34 % , 95 % CI 20–51 ) , with a median duration of 14·5 days ( IQR 6·0–16·5 ) . Urinary tract infection was noted in seven men ( 17 % , 95 % CI 7–32 ) . Median overall International Index of Erectile Function-15 ( IIEF-15 ) scores were similar at baseline and at 12 months ( p=0·060 ) , as were median IIEF-15 scores for intercourse satisfaction ( p=0·454 ) , sexual desire ( p=0·644 ) , and overall satisfaction ( p=0·257 ) . Significant deteriorations between baseline and 12 months were noted for IIEF-15 erectile ( p=0·042 ) and orgasmic function ( p=0·003 ) . Of 35 men with good baseline function , 31 ( 89 % , 95 % CI 73–97 ) had erections sufficient for penetration 12 months after focal therapy . Median UCLA Exp and ed Prostate Cancer Index Composite ( EPIC ) urinary incontinence scores were similar at baseline as and 12 months ( p=0·045 ) . There was an improvement in lower urinary tract symptoms , assessed by International Prostate Symptom Score ( IPSS ) , between baseline and 12 months ( p=0·026 ) , but the IPSS- quality of life score showed no difference between baseline and 12 months ( p=0·655 ) . All 38 men with no baseline urinary incontinence were leak-free and pad-free by 9 months . All 40 men pad-free at baseline were pad-free by 3 months and maintained pad-free continence at 12 months . No significant difference was reported in median Trial Outcomes Index scores between baseline and 12 months ( p=0·113 ) but significant improvement was shown in median Functional Assessment of Cancer Therapy (FACT)-Prostate ( p=0·045 ) and median FACT-General scores ( p=0·041 ) . No histological evidence of cancer was identified in 30 of 39 men biopsied at 6 months ( 77 % , 95 % CI 61–89 ) ; 36 ( 92 % , 79–98 ) were free of clinical ly significant cancer . After retreatment in four men , 39 of 41 ( 95 % , 95 % CI 83–99 ) had no evidence of disease on multiparametric MRI at 12 months . Interpretation Focal therapy of individual prostate cancer lesions , whether multifocal or unifocal , leads to a low rate of genitourinary side-effects and an encouraging rate of early absence of clinical ly significant prostate cancer . Funding Medical Research Council ( UK ) , Pelican Cancer Foundation , and St Peters Trust Active surveillance followed by selective treatment for men who have evidence of disease progression may be an option for select patients with early‐stage prostate cancer . In this article , the authors report their experience in a contemporary cohort of men with prostate cancer who were managed with active surveillance BACKGROUND In 2008 , we reported that radical prostatectomy , as compared with watchful waiting , reduces the rate of death from prostate cancer . After an additional 3 years of follow-up , we now report estimated 15-year results . METHODS From October 1989 through February 1999 , we r and omly assigned 695 men with early prostate cancer to watchful waiting or radical prostatectomy .  Follow-up was complete through December 2009 , with histopathological review of biopsy and radical-prostatectomy specimens and blinded evaluation of causes of death . Relative risks , with 95 % confidence intervals , were estimated with the use of a Cox proportional-hazards model . RESULTS During a median of 12.8 years , 166 of the 347 men in the radical-prostatectomy group and 201 of the 348 in the watchful-waiting group died ( P=0.007 ) . In the case of 55 men assigned to surgery and 81 men assigned to watchful waiting , death was due to prostate cancer . This yielded a cumulative incidence of death from prostate cancer at 15 years of 14.6 % and 20.7 % , respectively ( a difference of 6.1 percentage points ; 95 % confidence interval [ CI ] , 0.2 to 12.0 ) , and a relative risk with surgery of 0.62 ( 95 % CI , 0.44 to 0.87 ; P=0.01 ) . The survival benefit was similar before and after 9 years of follow-up , was observed also among men with low-risk prostate cancer , and was confined to men younger than 65 years of age . The number needed to treat to avert one death was 15 overall and 7 for men younger than 65 years of age . Among men who underwent radical prostatectomy  , those with extracapsular tumor growth had a risk of death from prostate cancer that was 7 times that of men without extracapsular tumor growth ( relative risk , 6.9 ; 95 % CI , 2.6 to 18.4 ) . CONCLUSIONS Radical prostatectomy was associated with a reduction in the rate of death from prostate cancer . Men with extracapsular tumor growth may benefit from adjuvant local or systemic treatment . ( Funded by the Swedish Cancer Society and the National Institutes of Health . ) INTRODUCTION The sub Comittee prostate of the CCAFU established guidelines for diagnostic , treatment , evaluation and st and art of care of prostate cancer . METHODS Guidelines 2010 were up date d based on systematic literature search performed by the sub-Comittee in Medline and PubMed data bases to evaluate references , levels of evidence and grade of recomm and ation . RESULTS Pathological examination of the tissue specimens was defined specifically for Gleason score according to ISP 2005 recomm and ations . Prostate and pelvis RMN became the reference in terms of radiological exam . Individual and early diagnosis of prostate cancer was defined and role of PSA was precised . Active surveillance became one of the st and art of care of low-risk tumors , radical prostatectomy remained one of the options for all risk group tumors , length of hormonotherapy in association with radiotherapy was precised according to the risk group . Side effects of  hormonotherapy  treament needed specific supervision ; hormonotherapy had no indication in case of non metastatic tumors and intermittent hormonotherapy in metastatic tumors . New hormonal drugs in pre and post chemotherapy and bone target drugs opened new therapeutics pathways . CONCLUSION From 2010 to 2013 , st and arts of care of prostate cancer were modified because of results of prospect i ve studies and new therapeutics . They allowed precise treatments for each specific clinical situation . In the future , multidisciplinary treatments for high risk tumors , time of adjuvant treatment and sequencies of new hormonal treatment had to be defined BACKGROUND Active surveillance ( AS ) aims to allow men with favourable-risk , localised prostate cancer to avoid unnecessary treatment . OBJECTIVE To describe the clinical outcomes of a prospect i ve study of AS . DESIGN , SETTING , AND PARTICIPANTS A single-centre , prospect i ve cohort study . Eligibility criteria included histologically proven prostate adenocarcinoma , age 50 - 80 yr , stage T1/T2 , prostate-specific antigen level ( PSA ) < 15 ng/ml , Gleason score ( GS ) ≤ 3 + 3 ( GS ≤ 3 + 4 if aged > 65 yr ) , and percent positive biopsy cores ( PPC ) ≤ 50 % . INTERVENTION Patients were assessed by  serum PSA level , and digital rectal examination  at 3-mo intervals in year 1 , 4-mo intervals in year 2 , and at 6-mo intervals thereafter . Transrectal ultrasound-guided prostate biopsy was performed after 18 - 24 mo and every 2 yr thereafter . Treatment was recommended for PSA velocity ( PSAV ) > 1 ng/ml per year or adverse histology , defined as GS ≥ 4 + 3 or PPC > 50 % . OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS Outcomes described , using Kaplan-Meier methods , were rate of adverse histology on repeat biopsy , freedom from treatment , biochemical control after deferred treatment , and overall survival . Analyses using Cox regression were performed to determine predictors of deferred treatment and adverse histology . RESULTS AND LIMITATIONS The study enrolled 471 eligible patients from 2002 to 2011 . Median age was 66 yr and median initial PSA value was 6.4 ng/ml . Eighty-eight percent of patients had T1 disease and 93 % had GS ≤ 3 + 3 . At median follow-up of 5.7 yr , the 5-yr rate of adverse histology and treatment-free probability was 22 % ( 95 % confidence interval [ CI ] , 16 - 29 % ) and 70 % ( 95 % CI , 65 - 75 % ) , respectively . There were two deaths from prostate cancer . Predictors of time to adverse histology were GS 7 , PSAV > 1 ng/ml per year , low ratio of free PSA to total PSA , and PPC > 25 % . Longer follow-up is needed to confirm the safety of this strategy . CONCLUSIONS This study demonstrates satisfactory medium-term outcomes for AS in selected men with localised prostate cancer BACKGROUND We aim ed to investigate the safety and efficacy of dutasteride , a 5α-reductase inhibitor , on prostate cancer progression in men with low-risk disease who chose to be followed up with active surveillance . METHODS In our 3 year , r and omised , double-blind , placebo-controlled study , undertaken at 65 academic medical centres or outpatient clinics in North America , we enrolled men aged 48 - 82 years who had low-volume , Gleason score 5 - 6 prostate cancer and had chosen to be followed up with active surveillance . We r and omly allocated participants in a one-to-one ratio , stratified by site and in block sizes of four , to receive once-daily dutasteride 0·5 mg or matching placebo . Participants were followed up for 3 years , with 12-core prostate biopsy sample s obtained after 18 months and 3 years . The primary endpoint was time to prostate cancer progression , defined as the number of days between the start of study treatment and the earlier of either pathological progression ( in patients with ≥1 biopsy assessment after baseline ) or therapeutic progression ( start of medical therapy ) . This trial is registered with Clinical Trials.gov , number NCT00363311 . FINDINGS Between Aug 10 , 2006 , and March 26 , 2007 , we r and omly allocated 302 participants , of whom 289 ( 96 % ) had at least one biopsy procedure after baseline and were included in the primary analysis . By 3 years , 54 ( 38 % ) of 144 men in the dutasteride group and 70 ( 48 % ) of 145 controls had prostate cancer progression ( pathological or therapeutic ; hazard ratio 0·62 , 95 % CI 0·43 - 0·89 ; p=0·009 ) . Incidence of adverse events was much the same between treatment groups . 35 ( 24 % ) men in the dutasteride group and 23 ( 15 % ) controls had sexual adverse events or breast enlargement or tenderness . Eight ( 5 % ) men in the dutasteride group and seven ( 5 % ) controls had cardiovascular adverse events , but there were no prostate cancer-related deaths or instances of metastatic disease . INTERPRETATION Dutasteride could provide a beneficial adjunct to active surveillance for men with low-risk prostate cancer . FUNDING GlaxoSmithKline BACKGROUND The optimal selection of prostate cancer ( PCa ) patients for active surveillance ( AS ) is currently being debated . OBJECTIVE To assess the impact of urinary prostate cancer antigen 3 ( PCA3 ) score as an AS criterion instead of and in addition to the current criteria . DESIGN , SETTING , AND PARTICIPANTS We prospect ively studied 106 consecutive low-risk PCa patients ( prostate-specific antigen [ PSA ] ≤10 ng/ml , clinical stage T1c-T2a , and biopsy Gleason score 6 ) who underwent a PCA3 urine test before radical prostatectomy ( RP ) .  MEASUREMENTS Performance of AS criteria ( biopsy criteria , PCA3 score , PSA density , and magnetic resonance imaging [ MRI ] findings ) was tested in predicting four prognostic pathologic findings in RP specimens : ( 1 ) pT3 - 4 disease ; ( 2 ) overall unfavourable disease ( OUD ) defined by pT3 - 4 disease and /or pathologic primary Gleason pattern 4 ; ( 3 ) tumour volume < 0.5 cm(3 ) ; and ( 4 ) insignificant PCa . RESULTS AND LIMITATIONS The PCA3 score was strongly correlated with the tumour volume in a linear regression analysis ( p<0.001 , r=0.409 ) . The risk of having a cancer ≥0.5 cm(3 ) and a significant PCa was increased three-fold in men with a PCA3 score of ≥25 compared with men with a PCA3 score of < 25 with most AS biopsy criteria used . There was a trend towards higher PCA3 scores in patients with unfavourable and non-organ-confined disease and Gleason > 6 cancers . In a multivariate analysis taking into account each AS criterion , a high PCA3 score ( ≥25 ) was an important predictive factor for tumour volume ≥0.5 cm(3 ) ( odds ratio [ OR ] : 5.4 ; p=0.010 ) and significant PCa ( OR : 12.7 ; p=0.003 ) . Biopsy criteria and MRI findings were significantly associated with OUD ( OR : 3.9 and 5.0 , respectively ; p=0.030 and p=0.025 , respectively ) . CONCLUSIONS PCA3 score may be a useful marker to improve the selection for AS in addition to the current AS criteria . With a predictive cut-off of 25 , PCA3 score is strongly indicative for tumour volume and insignificant PCa CONTEXT Prostate-specific antigen screening has led to an increase in the diagnosis and treatment of localized prostate cancer . However , the role of active treatment of low- and intermediate-risk disease in elderly men is controversial . OBJECTIVE To estimate the association between treatment ( with radiation therapy or radical prostatectomy ) compared with observation and overall survival in men with low- and intermediate-risk prostate cancer . DESIGN AND SETTING Observational US cohort from Surveillance , Epidemiology , and End Results Medicare data . PATIENTS At total of 44,630 men aged 65 to 80 years who were diagnosed between 1991 and 1999 with organ-confined , well- or moderately differentiated prostate cancer and who had survived more than a year past diagnosis . Patients were followed up until death or study end ( December 31 , 2002 ) . Patients were classified as having received treatment ( n=32,022 ) if they had cl aims for radical prostatectomy or radiation therapy during the first 6 months after diagnosis . They were classified as having received observation ( n=12,608 ) if they did not have cl aims for radical prostatectomy , radiation , or hormonal therapy . Patients who received only hormonal therapy were excluded . MAIN OUTCOME MEASURE Overall survival . RESULTS At the end of the 12-year study period , 4663 men ( 37 % ) in the observational group and 7639 men ( 23.8 % ) in the treatment group had died . The treatment group had longer 5- and 10-year survival than the observation group . After using propensity scores to adjust for potential confounders ( tumor characteristics , demographics , and comorbidities ) , there was a statistically significant survival advantage associated with treatment ( hazard ratio , 0.69 ; 95 % confidence interval , 0.66 - 0.72 ) . A benefit associated with treatment was seen in all subgroups examined , including older men ( aged 75 - 80 years at diagnosis ) , black men , and men with low-risk disease . CONCLUSIONS This study suggests a survival advantage is associated with active treatment for low- and intermediate-risk prostate cancer in elderly men aged 65 to 80 years . Because observational data can not completely adjust for potential selection bias and confounding , these results must be vali date d in r and omized controlled trials of alternative management strategies in elderly men with localized prostate cancer PURPOSE To determine utility of multiparametric imaging performed at 3 T for detection of prostate cancer by using T2-weighted magnetic resonance ( MR ) imaging , MR spectroscopy , and dynamic contrast material -enhanced MR imaging , with whole-mount pathologic findings as reference st and ard . MATERIAL S AND METHODS This prospect ively design ed , HIPAA-compliant , single-institution study was approved by the local institutional review board . Seventy consecutive patients ( mean age , 60.4 years ; mean prostate-specific antigen level , 5.47 ng/mL [ 5.47 microg/L ] ; range , 1 - 19.9 ng/mL [ 1 - 19.9 microg/L ] ) were included ; informed consent was obtained from each patient . All patients had biopsy-proved prostate cancer , with a median Gleason score of 7 ( range , 6 - 9 ) . Images were obtained by using a combination of six-channel cardiac and endorectal coils . MR imaging and pathologic findings were evaluated independently and blinded and then correlated with histopathologic findings by using side-by-side comparison . Analyses were conducted with a raw stringent approach and an alternative neighboring method , which accounted for surgical deformation , shrinkage , and nonuniform slicing factors in pathologic specimens . Generalized estimating equations ( GEEs ) were used to estimate the predictive value of region-specific , pathologically determined cancer for all three modalities . This approach accounts for the correlation among multiple regions in the same individual . RESULTS For T2-weighted MR imaging , sensitivity and specificity values obtained with stringent approach were 0.42 ( 95 % confidence interval [ CI ] : 0.36 , 0.47 ) and 0.83 ( 95 % CI : 0.81 , 0.86 ) , and for the alternative neighboring approach , sensitivity and specificity values were 0.73 ( 95 % CI : 0.67 , 0.78 ) and 0.89 ( 95 % CI : 0.85 , 0.93 ) , respectively . The combined diagnostic accuracy of T2-weighted MR imaging , dynamic contrast-enhanced MR imaging , and MR spectroscopy for peripheral zone tumors was examined by calculating their predictive value with different combinations of techniques ; T2-weighted MR imaging , dynamic contrast-enhanced MR imaging , and MR spectroscopy provided significant independent and additive predictive value when GEEs were used ( P < .001 , P = .02 , P = .002 , respectively ) . CONCLUSION Multiparametric MR imaging ( T2-weighted MR imaging , MR spectroscopy , dynamic contrast-enhanced MR imaging ) of the prostate at 3 T enables tumor detection , with reasonable sensitivity and specificity values To evaluate the optimal treatment conditions and effects of TOOKAD ® Soluble vascular‐targeted photodynamic ( VTP ) therapy in patients with localised prostate cancer . To evaluate the safety and quality of life after TOOKAD ® Soluble VTP treatment in patients with localised prostate cancer BACKGROUND Detection of fusion gene TMPRSS2:ERG transcripts in urine have been recently described in order to refine urine-based detection of prostate cancer ( PCa ) , but data its clinical impact remain scarce . We aim ed at investigating the correlation of TMPRSS2:ERG , prostate cancer antigen 3 ( PCA3 ) , prostate specific antigen ( PSA ) density , genetic variants , and and rogenic status with outcome and pathological findings at prostatic biopsy . METHODS Between 2007 and 2011 , 291 patients at risk of PCa because of PSA > 3.0 ng/ml ( 55 % ) or c and i date to active surveillance protocol justifying restaging biopsy management ( 45 % ) were recruited .  TMPRSS2:ERG  was detected by urine assay ( Progensa ™ ) . PCA3-score , PSA level , bioavailable testosterone level , prostate volume , rs1447295 and rs6983267 genotypes were prospect ively assessed . Univariate and multivariate analysis by logistic regression model ( logit ) were conducted to study the correlation of TMPRSS2:ERG status , PCA3 , and PSA density with biopsy results , and Gleason score . RESULTS Of 291 patients , 173 had PCa and 118 had negative biopsy . PCA3 score , PSA density and TMPRSS2:ERG-score were correlated with presence of PCa ( P < 0.0001 , P = 0.046 , and P < 0.0001 , respectively ) . This correlation remained strong on multivariable analysis model ( area under curve 0.743 ) . PCA3 score and PSA density were significantly associated with presence of Grade 4 through multivariable analysis . PCA3 score was also correlated to the percentage of positive cores at biopsy ( P = 0.008 ) . CONCLUSIONS Integration of levels TMPRSS2:ERG transcripts in urine , with PCA3-score , and rogenic status , genetic status and traditional clinical variables could significantly increase detection of high risk localized PCa BACKGROUND And rogens are involved in the development of prostate cancer . Finasteride , an inhibitor of 5alpha-reductase , inhibits the conversion of testosterone to dihydrotestosterone , the primary and rogen in the prostate , and may reduce the risk of prostate cancer . METHODS In the Prostate Cancer Prevention Trial , we r and omly assigned 18,882 men 55 years of age or older with a normal digital rectal examination and a prostate-specific antigen ( PSA ) level of 3.0 ng per milliliter or lower to treatment with finasteride ( 5 mg per day ) or placebo for seven years .  Prostate biopsy was recommended if the annual PSA level , adjusted for the effect of finasteride , exceeded 4.0 ng per milliliter or if the digital rectal examination was abnormal . It was anticipated that 60 percent of participants would have prostate cancer diagnosed during the study or would undergo biopsy at the end of the study . The primary end point was the prevalence of prostate cancer during the seven years of the study . RESULTS Prostate cancer was detected in 803 of the 4368 men in the  finasteride  group who had data for the final analysis ( 18.4 percent ) and 1147 of the 4692 men in the placebo group who had such data ( 24.4 percent ) , for a 24.8 percent reduction in prevalence over the seven-year period ( 95 percent confidence interval , 18.6 to 30.6 percent ; P<0.001 ) . Tumors of Gleason grade 7 , 8 , 9 , or 10 were more common in the finasteride group ( 280 of 757 tumors [ 37.0 percent ] , or 6.4 percent of the 4368 men included in the final analysis ) than in the placebo group ( 237 of 1068 tumors [ 22.2 percent ] , P<0.001 for the comparison between groups ; or 5.1 percent of the 4692 men included in the final analysis , P=0.005 for the comparison between groups ) . Sexual side effects were more common in finasteride-treated men , whereas urinary symptoms were more common in men receiving placebo . CONCLUSIONS Finasteride prevents or delays the appearance of prostate cancer , but this possible benefit and a reduced risk of urinary problems must be weighed against sexual side effects and the increased risk of high- grade prostate cancer PURPOSE We assessed the outcome of a watchful-waiting protocol with selective delayed intervention by using clinical prostate-specific antigen ( PSA ) , or histologic progression as treatment indications for clinical ly localized prostate cancer . PATIENTS AND METHODS This was a prospect i ve , single-arm , cohort study . Patients were managed with an initial expectant approach . Definitive intervention was offered to those patients with a PSA doubling time of less than 3 years , Gleason score progression ( to 4 + 3 or greater ) , or unequivocal clinical progression .  Survival analysis and Cox proportional hazard model were applied to the data . Results A total of 450 patients have been observed with active surveillance . Median follow-up was 6.8 years ( range , 1 to 13 years ) . Overall survival was 78.6 % . The 10-year prostate cancer actuarial survival was 97.2 % . Overall , 30 % of patients have been reclassified as higher risk and have been offered definitive therapy . Of 117 patients treated radically , the PSA failure rate was 50 % , which was 13 % of the total cohort . PSA doubling time of 3 years or less was associated with an 8.5-times higher risk of biochemical failure after definitive treatment compared with a doubling time of more than 3 years ( P < .0001 ) . The hazard ratio for nonprostate cancer to prostate cancer mortality was 18.6 at 10 years . CONCLUSION We observed a low rate of prostate cancer mortality . Among the patients who were reclassified as higher risk and who were treated , PSA failure was relatively common . Other-cause mortality accounted for almost all of the deaths . Additional studies are warranted to improve the identification of patients who harbor more aggressive disease despite favorable clinical parameters at diagnosis
INTRODUCTION The widespread use of prostate cancer screening has led to a stage migration result ing in an increase in the diagnosis of low-risk disease , which currently accounts for 40 - 50 % of diagnosed forms .
New therapeutic strategies have been developed in order to minimize the risk of overtreatment .
RESULTS Low-risk tumors are conventionally defined by the d'Amico classification .