title: Indications for intervention during active surveillance of prostate cancer: a comparison of the Johns Hopkins and Prostate Cancer Research International Active Surveillance (PRIAS) protocols.
abstract: OBJECTIVE
  To analyse how patients enrolled in our biopsy based surveillance programme would fare under the Prostate Cancer Research International Active Surveillance (PRIAS) protocol, which uses PSA kinetics.
  
  
  METHODS
  Since 1995, 1125 men with very-low-risk prostate cancer have enrolled in the AS programme at the Johns Hopkins Hospital (JHH), which is based on monitoring with annual biopsy. The PRIAS protocol uses a combination of periodic biopsies (in years 1, 4, and 7) and prostate-specific antigen doubling time (PSADT) to trigger intervention. Patients enrolled in the JHH AS programme were retrospectively reviewed to evaluate how the use of the PRIAS protocol would alter the timing and use of curative intervention.
  
  
  RESULTS
  Over a median of 2.1 years of follow up, 38% of men in the JHH AS programme had biopsy reclassification. Of those, 62% were detected at biopsy intervals corresponding to the PRIAS criteria, while 16% were detected between scheduled PRIAS biopsies, resulting in a median delay in detection of 1.9 years. Of the 202 men with >5 years of follow-up, 11% in the JHH programme were found to have biopsy reclassification after it would have been identified in the PRIAS protocol, resulting in a median delay of 4.7 years to reclassification. In all, 12% of patients who would have undergone immediate intervention under PRIAS due to abnormal PSA kinetics would never have undergone reclassification on the JHH protocol and thus would not have undergone definitive intervention.
  
  
  CONCLUSIONS
  There are clear differences between PSA kinetics-based AS programmes and biopsy based programmes. Further studies should address whether and how the differences in timing of intervention impact subsequent disease progression and prostate cancer mortality.
authors.affiliation: James Buchanan Brady Urological Institute, Johns Hopkins Medical Institutions, Baltimore, MD, USA.
authors.forename: Max
authors.initials: M
authors.lastname: Kates
authors.forename: Jeffrey J
authors.initials: JJ
authors.lastname: Tosoian
authors.forename: Bruce J
authors.initials: BJ
authors.lastname: Trock
authors.forename: Zhaoyong
authors.initials: Z
authors.lastname: Feng
authors.forename: H Ballentine
authors.initials: HB
authors.lastname: Carter
authors.forename: Alan W
authors.initials: AW
authors.lastname: Partin
mesh_terms: D001706:Biopsy / Q000009:adverse effects; D002985:Clinical Protocols; D018450:Disease Progression; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D011159:Population Surveillance; D011467:Prostate / Q000473:pathology*; D017430:Prostate-Specific Antigen / Q000097:blood*; D011471:Prostatic Neoplasms / Q000097:blood / Q000453:epidemiology / Q000473:pathology* / Q000517:prevention & control; D015203:Reproducibility of Results; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D014481:United States / Q000453:epidemiology; D057832:Watchful Waiting
chemical_list: D017430:Prostate-Specific Antigen
keywords: PSA; active surveillance; prostate biopsy; prostate cancer