URO ONCO

Welcome, this website is intended for all international healthcare professionals in uro-oncology. By clicking the link below you are declaring and confirming that you are a healthcare professional.

You are here

Extended followup and risk factors for disease reclassification in a large active surveillance cohort for localized prostate cancer

J Urol. 2015 Mar;193(3):807-11

J Urol. 2015 Mar;193(3):807-11

Abstract

PURPOSE:

Active surveillance to manage prostate cancer provides an alternative to immediate treatment in men with low risk prostate cancer. We report updated outcomes from a long-standing active surveillance cohort and factors associated with reclassification.

MATERIALS AND METHODS:

We retrospectively reviewed data on all men enrolled in the active surveillance cohort at our institution with at least 6 months of followup between 1990 and 2013. Surveillance consisted of quarterly prostate specific antigen testing, repeat imaging with transrectal ultrasound at provider discretion and periodic repeat prostate biopsies. Factors associated with repeat biopsy reclassification and local treatment were determined by multivariate Cox proportional hazards regression. We also analyzed the association of prostate specific antigen density and outcomes stratified by prostate size.

RESULTS:

A total of 810 men who consented to participate in the research cohort were followed on active surveillance for a median of 60 months. Of these men 556 (69%) met strict criteria for active surveillance. Five-year overall survival was 98%, treatment-free survival was 60% and biopsy reclassification-free survival was 40%. There were no prostate cancer related deaths. On multivariate analysis prostate specific antigen density was positively associated with the risk of biopsy reclassification and treatment while the number of biopsies and time between biopsies were inversely associated with the 2 outcomes (each p <0.01). When stratified by prostate volume, prostate specific antigen density remained significantly associated with biopsy reclassification for all strata but prostate specific antigen density was only significantly associated with treatment in men with a smaller prostate.

CONCLUSIONS:

Significant prostate cancer related morbidity and mortality remained rare at intermediate followup. Prostate specific antigen density was independently associated with biopsy reclassification and treatment while on active surveillance.

KEYWORDS:

biopsy; disease progression; outcome assessment; prostate-specific antigen; prostatic neoplasms

Copyright © PubMed Central

Comment from Henk van der Poel:  The field of active surveillance management of low risk prostate cancer is completely void of randomized studies. Rather surprising considering the tremendous impact of a delayed diagnosis of high risk prostate cancer for several years. At 5 years prostate cancer specific mortality is low despite biopsy reclassification in the majority of men. Longer follow-up is needed to answer the question whether AS is delaying rather than preventing treatment and whether this delay will result in PCA related death in some.

E-Alert

Subscribe to our E-Alert to keep up to date with the new items in the Resource Centre

Subscribe

URO ONCO is made possible by an unrestricted educational grant from:

The editorial independence of the resource centre is mandatory and recognized by the EAU and Elsevier.

The journal articles, videos and statements published on the resource centre have been selected independently and without influence from Elsevier, European Urology Editors or the sponsor and do not necessarily reflect their opinions or views.