Active surveillance represents a strategy to address the overtreatment of prostate cancer, yet uncertainty regarding individual patient outcomes remains a concern. We evaluated outcomes in a prospective multi-center study of active surveillance.
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We studied 905 men in the prospective Canary Prostate cancer Active Surveillance Study (PASS) enrolled between 2008 to 2013. We collected clinical data at study entry and at pre-specified intervals and determined associations with adverse reclassification defined as increased Gleason grade or greater cancer volume on follow-up biopsy. We also evaluated the relationships of clinical parameters with pathology findings in participants who underwent surgery after a period of active surveillance.
During a median follow-up of 28 months, 24% of participants experienced adverse reclassification, of whom 53% underwent treatment while 31% continued active surveillance. Overall, 19% of participants received treatment, 68% with adverse reclassification while 32% opted for treatment without disease reclassification. In multivariate Cox proportional hazards modeling, percent of biopsy cores with cancer, BMI, and PSA density were associated with adverse reclassification (P = 0. 01, 0. 04, 0. 04). Of 103 participants subsequently treated by radical prostatectomy, 34% had adverse pathology, defined as primary pattern 4-5 or non-organ confined disease, including two with positive lymph nodes, with no significant relationship between risk category at diagnosis and findings at surgery (P = 0. 76).
Most men remain on active surveillance at five years without adverse reclassification or adverse pathology at surgery. However, clinical factors had only modest association with disease reclassification, supporting the need for approaches that improve prediction of this outcome.
The Journal of urology. 2015 Aug 28 [Epub ahead of print]
Lisa F Newcomb, Ian M Thompson, Hilary D Boyer, James D Brooks, Peter R Carroll, Matthew R Cooperberg, Atreya Dash, William J Ellis, Ladan Fazli, Ziding Feng, Martin E Gleave, Priya Kunju, Raymond S Lance, Jesse K McKenney, Maxwell V Meng, Marlo M Nicolas, Martin G Sanda, Jeffry Simko, Alan So, Maria S Tretiakova, Dean A Troyer, Lawrence D True, Funda Vakar-Lopez, Jeff Virgin, Andrew A Wagner, John T Wei, Yingye Zheng, Peter S Nelson, Daniel W Lin, Canary Prostate Active Surveillance Study Investigators
Fred Hutchinson Cancer Research Center; University of Washington. , University of Texas Health Sciences Center at San Antonio. , Fred Hutchinson Cancer Research Center. , Stanford University. , University of California at San Francisco. , University of California at San Francisco. , Veterans Affairs Puget Sound Health Care System. , University of Washington. , University of British Columbia. , Fred Hutchinson Cancer Research Center. , University of British Columbia. , University of Michigan. , Eastern Virginia Medical School. , (10)Cleveland Clinic. , University of California at San Francisco. , University of Texas Health Sciences Center at San Antonio. , Beth Israel Deaconess Medical Center. , University of California at San Francisco. , University of British Columbia. , University of Washington. , Eastern Virginia Medical School. , University of Washington. , University of Washington. , Veterans Affairs Puget Sound Health Care System. , Beth Israel Deaconess Medical Center. , University of Michigan. , Fred Hutchinson Cancer Research Center. , Fred Hutchinson Cancer Research Center. , Fred Hutchinson Cancer Research Center; University of Washington; Veterans Affairs Puget Sound Health Care System.