AUA 2018: Long-Term Outcomes of Active Surveillance for Prostate Cancer - Memorial Sloan Kettering Cancer Center Experience

San Francisco, CA (  Active surveillance is a well accepted treatment paradigm for patients with low risk prostate cancer. However, long-term outcomes are limited to a relatively small number of centers with differing inclusion criteria. Therefore, increasing knowledge regarding these outcomes is valuable. In a podium presentation at the American Urologic Association Annual Meeting, Dr. Benfante and colleagues present a 17-year experience with active surveillance (AS) at the Memorial Sloan Kettering Cancer Center. 

The authors undertook a retrospective analysis of all patients managed with AS from 2000-2017. During this time, their center recommended confirmatory biopsy prior to enrollment on AS. MRI was used increasingly over time. Once on AS, patients underwent semi-annual evaluation with digital rectal examination, prostate specific antigen (PSA) testing and overall medical review. Biopsy, while not protocolized, was generally performed every 2-3 years or when prompted by changes in clinical status, MRI findings, or PSA. Intervention was undertaken on the basis of patient preference, upgrading or upstaging. 

Over the 17 year time frame, the authors identified 2009 patients who underwent AS, 91% of whom had Gleason Grade Group 1 on biopsy, 8% had Grade Group 2, and 1% had Grade Group 3. The median follow-up was 4.2 years (2.2-6.7 years). Median age at diagnosis was 63 years, though this trended from older patients in the earlier years of the cohort to younger patients more recently. Treatment-free survival rates were estimated at 74% at 5 years, 62% at 10 years, and 56% at 15 years. Concordantly, upgrading occurred in 24% at 5 years, 36% at 10 years, and 43% at 15 years. 10 year metastasis free survival was 98%. During follow-up, 2 patients died of prostate cancer, with a 10 year cancer specific survival of 100% and overall survival of 92%. 

The authors conclude that their experience at MSKCC mirrors prior reports with low rates of metastasis or cancer-related deaths for patients on active surveillance. 

Presented By: Nicole Benfante 
Co-authors: Sigrid Carlsson, Ricardo Alvim, Daniel D Sjoberg, Behfar Ehdaie, Peter Scardino, James Eastham, Karim Touijer 

Written by: Christopher J.D. Wallis, Urology Resident, University of Toronto, Twitter: @WallisCJDat the 2018 AUA Annual Meeting - May 18 - 21, 2018 – San Francisco, CA USA