Active surveillance for low-risk prostate cancer: Need for intervention and survival at 10 years

INTRODUCTION - To describe the need for treatment and cancer-specific and overall survival in a contemporary active surveillance (AS) cohort.

METHODS - Historical cohort study of men diagnosed with localized prostate cancer between 1997 and 2009 and managed with AS at a tertiary care center. Inclusion criteria were Gleason score≤6 (Gleason score of 7 in select patients),≤3/12 cores positive, and prostate-specific antigen (PSA) level<20ng/ml. Survival analyses were conducted using the Kaplan-Meier method.

RESULTS - A total of 469 men with median age at diagnosis of 68.1 years (interquartile range [IQR]: 62.5-73.4) were followed up for a median of 4.8 years (IQR: 3.4-7.3). Median PSA level at diagnosis was 5.1ng/ml (IQR: 4.0-6.9), with 94% of them having PSA level<10ng/ml. Overall, 98.3% (461/469) of patients had a Gleason score of 6 and 1.7% (8/469) had a Gleason score of 3+4 = 7, and 94.0% (441/469) had T1c stage disease. Freedom from treatment was 77% at 5 years and 62% at 10 years. A total of 116 (24.7%) patients received treatment during the course of surveillance. Reasons for treatment included 44.8% (52/116) for pathologic reclassification, 30.2% (35/116) for PSA progression, 12.1% (14/116) for patient preference, 5.2% (6/116) for digital rectal examination progression, and 4.3% (5/116) for metastatic disease. Of the patients treated, 59 (50.1%) received radiation, 26 (22.4%) underwent surgery, 17 (14.7%) received brachytherapy, and 14 (12.1%) received androgen-deprivation therapy. Cancer-specific survival was 100% at 5 and 10 years. Overall survival was 95% at 5 years and 88% at 10 years.

CONCLUSIONS - In a contemporary cohort of men with low-risk prostate cancer, AS allowed avoidance of treatment most of them. Common reasons for change in management were Gleason upgrading and volume progression on prostate rebiopsy.

Urol Oncol. 2015 Jun 6. pii: S1078-1439(15)00194-5. doi: 10.1016/j.urolonc.2015.04.015. [Epub ahead of print]

Preston MA1, Feldman AS2, Coen JJ3, McDougal WS4, Smith MR5, Paly JJ3, Carrasquillo R6, Wu CL4, Dahl DM4, Barrisford GW4, Blute ML4, Zietman AI3.

1 Division of Urology, Department of Surgery, Brigham and Women's Hospital, Boston, MA.
2 Department of Urology, Massachusetts General Hospital, Boston, MA.
3 Department of Radiation Oncology, Massachusetts General Hospital, Boston, MA.
4 Department of Urology, Massachusetts General Hospital, Boston, MA.
5 Division of Medical Oncology, Massachusetts General Hospital, Boston, MA.
6 Department of Urology, Boston Medical Center, Boston, MA.

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