To assess long-term outcomes of men with favorable-risk prostate cancer in a prospective, active-surveillance program.
Curative intervention was recommended for disease reclassification to higher cancer grade or volume on prostate biopsy.
Primary outcomes were overall, cancer-specific, and metastasis-free survival. Secondary outcomes were the cumulative incidence of reclassification and curative intervention. Factors associated with grade reclassification and curative intervention were evaluated in a Cox proportional hazards model.
A total of 1,298 men (median age, 66 years) with a median follow-up of 5 years (range, 0. 01 to 18. 00 years) contributed 6,766 person-years of follow-up since 1995. Overall, cancer-specific, and metastasis-free survival rates were 93%, 99. 9%, and 99. 4%, respectively, at 10 years and 69%, 99. 9%, and 99. 4%, respectively, at 15 years. The cumulative incidence of grade reclassification was 26% at 10 years and was 31% at 15 years; cumulative incidence of curative intervention was 50% at 10 years and was 57% at 15 years. The median treatment-free survival was 8. 5 years (range, 0. 01 to 18 years). Factors associated with grade reclassification were older age (hazard ratio [HR], 1. 03 for each additional year; 95% CI, 1. 01 to 1. 06), prostate-specific antigen density (HR, 1. 21 per 0. 1 unit increase; 95% CI, 1. 12 to 1. 46), and greater number of positive biopsy cores (HR, 1. 47 for each additional positive core; 95% CI, 1. 26 to 1. 69). Factors associated with intervention were prostate-specific antigen density (HR, 1. 38 per 0. 1 unit increase; 95% CI, 1. 22 to 1. 56) and a greater number of positive biopsy cores (HR, 1. 35 for one additional positive core; 95% CI, 1. 19 to 1. 53).
Men with favorable-risk prostate cancer should be informed of the low likelihood of harm from their diagnosis and should be encouraged to consider surveillance rather than curative intervention.
Journal of clinical oncology : official journal of the American Society of Clinical Oncology. 2015 Aug 31 [Epub ahead of print]
Jeffrey J Tosoian, Mufaddal Mamawala, Jonathan I Epstein, Patricia Landis, Sacha Wolf, Bruce J Trock, H Ballentine Carter
All authors: The Johns Hopkins University School of Medicine, The James Buchanan Brady Urological Institute, Johns Hopkins Hospital, Baltimore, MD. , All authors: The Johns Hopkins University School of Medicine, The James Buchanan Brady Urological Institute, Johns Hopkins Hospital, Baltimore, MD. , All authors: The Johns Hopkins University School of Medicine, The James Buchanan Brady Urological Institute, Johns Hopkins Hospital, Baltimore, MD. , All authors: The Johns Hopkins University School of Medicine, The James Buchanan Brady Urological Institute, Johns Hopkins Hospital, Baltimore, MD. , All authors: The Johns Hopkins University School of Medicine, The James Buchanan Brady Urological Institute, Johns Hopkins Hospital, Baltimore, MD. , All authors: The Johns Hopkins University School of Medicine, The James Buchanan Brady Urological Institute, Johns Hopkins Hospital, Baltimore, MD. , All authors: The Johns Hopkins University School of Medicine, The James Buchanan Brady Urological Institute, Johns Hopkins Hospital, Baltimore, MD.