Intermediate-Term Outcomes of Men with Very Low/Low and Intermediate/High Risk Prostate Cancer Managed by Active Surveillance

To compare intermediate-term clinical outcomes among men with favorable risk and intermediate/high risk prostate cancer (PCa) managed with active surveillance (AS).

Since 2002, 635 men with localized PCa have been managed with AS at a high-volume U. S. academic hospital with a median follow-up of 50.5 months (IQR 31.1-80.3). Time to event analysis was performed for our clinical endpoints.

117 men (18.4% of the cohort) had intermediate/high risk disease. The overall 5- and 10-year all-cause survival was 98% and 94%, respectively. The cumulative metastasis-free survival at 5- and 10-years was 99% and 98%. To date, no cancer-specific deaths have been observed. The overall freedom from intervention was 61% and 49%, at 5- and 10-years respectively. Overall, the cumulative freedom from failure of AS--defined as the development of metastasis or biochemical failure after local therapy with curative intent- was 97% and 91% at 5- and 10-years, respectively. Twenty-one (9.9%) men experienced biochemical failure after deferred treatment and the 5-year progression free probability was 92%. Compared to men with favorable risk disease, men with intermediate/high risk cancer experienced no difference in metastases, surveillance failure, or curative intervention. However, higher risk patients experienced significantly higher risk of all-cause mortality, likely reflecting patient selection factors. These conclusions may be limited by the small number of events and duration of our study period.

Patients with localized prostate cancer on AS demonstrated a low rate of AS failure, prostate cancer specific mortality, metastases, regardless of baseline risk.

The Journal of urology. 2017 Mar 24 [Epub ahead of print]

Yaw A Nyame, Nima Almassi, Samuel C Haywood, Daniel J Greene, Vishnu Ganesan, Charles Dai, Joseph Zabell, Chad Reichard, Hans Arora, Anna Zampini, Alice Crane, Daniel Hettel, Ahmed Elshafei, Khaled Fareed, Robert J Stein, Ryan K Berglund, Michael Gong, J Stephen Jones, Eric A Klein, Andrew J Stephenson

Department of Urology, Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio., Department of Urology, Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio. Electronic address: .