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dc.contributor.authorGnanapragasam, Vincenten
dc.contributor.authorBarrett, Tristanen
dc.contributor.authorThankapannair, Vineethaen
dc.contributor.authorThurtle, Daviden
dc.contributor.authorRubio-Briones, Joseen
dc.contributor.authorDomínguez-Escrig, Joseen
dc.contributor.authorBratt, Olaen
dc.contributor.authorStatin, Paren
dc.contributor.authorMuir, Kennethen
dc.contributor.authorLophatananon, Artitayaen
dc.date.accessioned2019-05-10T23:30:46Z
dc.date.available2019-05-10T23:30:46Z
dc.date.issued2019-11en
dc.identifier.issn1464-4096
dc.identifier.urihttps://www.repository.cam.ac.uk/handle/1810/292682
dc.description.abstractOBJECTIVES: 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.
dc.format.mediumPrint-Electronicen
dc.languageengen
dc.rightsAll rights reserved
dc.rights.uri
dc.subjectHumansen
dc.subjectProstatic Neoplasmsen
dc.subjectDisease Progressionen
dc.subjectPrognosisen
dc.subjectRetrospective Studiesen
dc.subjectAgeden
dc.subjectMiddle Ageden
dc.subjectMaleen
dc.subjectWatchful Waitingen
dc.subjectNeoplasm Gradingen
dc.titleUsing prognosis to guide inclusion criteria, define standardised endpoints and stratify follow-up in active surveillance for prostate cancer.en
dc.typeArticle
prism.endingPage767
prism.issueIdentifier5en
prism.publicationDate2019en
prism.publicationNameBJU internationalen
prism.startingPage758
prism.volume124en
dc.identifier.doi10.17863/CAM.39835
dcterms.dateAccepted2019-05-01en
rioxxterms.versionofrecord10.1111/bju.14800en
rioxxterms.versionAM
rioxxterms.licenseref.urihttp://www.rioxx.net/licenses/all-rights-reserveden
rioxxterms.licenseref.startdate2019-11en
dc.contributor.orcidGnanapragasam, Vincent [0000-0003-4722-4207]
dc.contributor.orcidBarrett, Tristan [0000-0002-1180-1474]
dc.contributor.orcidThurtle, David [0000-0001-5636-7088]
dc.contributor.orcidBratt, Ola [0000-0002-9198-9445]
dc.identifier.eissn1464-410X
rioxxterms.typeJournal Article/Reviewen
cam.orpheus.successThu Jan 30 10:45:37 GMT 2020 - Embargo updated*
rioxxterms.freetoread.startdate2020-11-30


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