A single-center long-term experience of active surveillance for prostate cancer: 15 years of follow-up

• Published in: Investigative and clinical urology Vol. 62; no. 1; pp. 32 - 38
• Main Authors: Song, Sang Hun, Kim, Jung Kwon, Lee, Hakmin, Lee, Sangchul, Hong, Sung Kyu, Byun, Seok-Soo
• Format: Journal Article
• Language: English
• Published: Korea (South) The Korean Urological Association 01.01.2021; Korean Urological Association; 대한비뇨의학회
• Subjects: Adult; Aged; Biopsy; Disease Progression; Follow-Up Studies; Humans; Magnetic Resonance Imaging; Male; Middle Aged; Neoplasm Grading; Neoplasm Staging; Original; patient selection; Prostate - pathology; Prostate-Specific Antigen - blood; Prostatectomy; prostatic neoplasms; Prostatic Neoplasms - blood; Prostatic Neoplasms - diagnostic imaging; Prostatic Neoplasms - pathology; Prostatic Neoplasms - therapy; Retrospective Studies; Risk Factors; Time Factors; Treatment Outcome; Watchful Waiting; 비뇨기과학; Patient selection; Watchful waiting; Prostatic neoplasms
• ISSN: 2466-0493; 2466-054X; 2466-054X
• DOI: 10.4111/icu.20200206

To describe a single-center 15-year experience of active surveillance (AS) for prostate cancer (PCa). We retrospectively reviewed patients who underwent AS between 2003 and 2018. One hundred fifty-three patients were selected according to the following criteria: (1) biopsy Gleason pattern ≤3+4 with (2) ≤two positive core(s) and (3) ≤50% core involvement, clinical-stage ≤T2a, and prostate-specific antigen (PSA) ≤20 ng/mL. Follow-up included PSA measurement every six months, prostate biopsies at one year and then every 2-3 years, and MRI every year. Intervention was triggered by (1) Gleason score (GS) upgrading, (2) >two positive cores, or (3) PSA doubling-time in <3 years. Mean (±standard deviation) follow-up was 36.4 (±31.9) months. Ninety-three (60.8%) and 20 (13.1%) patients received second and third biopsies, respectively. Seventy-two patients (47.1%) discontinued AS for various reasons (59, intervention; 13, follow-up loss). Reasons for intervention consisted of GS upgrading (42.4%), >two positive cores (8.5%), abnormal PSA kinetics (11.9%), and patient preference (37.3%). Notably, 12 (25.5%) patients had pathologic GS ≥4+3 (unfavorable disease) and 3 (6.4%) patients had pathologic stage ≥T3a at radical prostatectomy. Median time to treatment-free survival was 19.5 months. Of the 59 patients who switched to intervention, biochemical recurrence was reported in only one (0.7%) patient. AS is an available option for low-risk PCa in carefully selected patients. Further larger prospective studies are needed to determine the optimal criteria for AS, especially in Korean PCa patients.