To report on the oncological outcomes of active surveillance (AS) in low-grade prostate cancer (PCa) patients using the French SurACaP protocol, with a focus on long-term outcomes.
This multicenter study recruited patients with low-grade PCa between 2007 and 2013 in four referral centers in France. The cohort included patients meeting the SurACaP inclusion criteria, i.e., aged ≤75years, with low-grade PCa (i.e., ISUP 1), clinical stage T1c/T2a, PSA ≤10ng/mL and ≤3 positive cores and tumor length ≤3mm per core. The SurACaP protocol included a digital rectal examination every six months, PSA level measurement every three months for the first two years after inclusion and twice a year thereafter, a confirmatory biopsy in the first year after inclusion, and then follow-up biopsy every two years or if disease progression was suspected. Multiparametric magnetic resonance imaging (mpMRI) was progressively included over the study period.
A total of 86 consecutive patients were included, with a median follow-up of 10.6 years. Only one patient developed metastases and died of PCa. The estimated rates of grade reclassification and treatment-free survival at 15 years were 53.4% and 21.2%, respectively. A negative mpMRI at baseline and a negative confirmatory biopsy were significantly associated with a lower risk of disease progression (P<0.05).
AS using the French SurACaP protocol is a safe and valuable strategy for patients with low-risk PCa, with excellent oncological outcomes after more than 10 years' follow-up. Future studies are crucial to broaden the inclusion criteria and develop a personalized, risk based AS protocol with the aim of de-escalating follow-up examinations.
Grade 4.
The French journal of urology. 2024 Feb 04 [Epub]
L Leclercq, C Bastide, E Lechevallier, J Walz, A-L Charvet, B Gondran-Tellier, J Campagna, P-Henri Savoie, T Long-Depaquit, L Daniel, D Rossi, G Pignot, M Baboudjian
Department of Urology, North Hospital, Aix-Marseille University, AP-HM, Marseille, France., Department of Urology, La Conception Hospital, Aix-Marseille University, AP-HM, Marseille, France., Department of Onco-urology, Institut Paoli Calmette, Marseille, France., Department of Urology, Hôpital d'instruction des armées de Sainte Anne, Toulon, France., Department of Pathology, Timone Hospital, Aix Marseille University AP-HM, Marseille, France., Department of Urology, North Hospital, Aix-Marseille University, AP-HM, Marseille, France. Electronic address: .