Long-term outcomes of active surveillance for prostate cancer: 10 years later.
170 Background: Prostate cancer (CaP) has exhibited a downward stage migration during the PSA era. Approximately 70% of those newly diagnosed with CaP, harbor tumors of low-risk. Such tumors often prove to be of low-volume and of clinical insignificance at time of radical prostatectomy (RP), suggesting over treatment and excessive exposure to the morbidity associated with definitive management. Over the last decade, active surveillance (AS) strategies have become a more accepted practice when addressing low-risk tumors. We present the long-term oncologic outcomes of patients placed on AS. Methods: An IRB approved retrospective chart review identified 114 patients placed on AS for their CaP between November of 1997 and November of 2000. Of those, 96 patients meet study inclusion criteria mandating a Gleason sum of < 7, tumor presence in < 4 sextets, and involvement of <50% of any single biopsy core. Eligible patients were surveyed by serum PSA , digital rectal exam, and surveillance transrectal ultrasound (TRUS)-guided biopsies at physician determined intervals. Results: At diagnosis, the mean age was 70.3 (SD±5.3) years with a mean PSA value of 8.2 (SD±8.2) ng/dL. Surveillance patterns approached acquisition of a PSA at a mean of 9 months and a TRUS-guided biopsy of the prostate every 1.5 years. The median total number of PSA’s and biopsies obtained while on surveillance were 6.0 (SD±5.72) and 3.5(SD±2.02), respectively. At a median follow-up of 134.8 months (95%CI: 114.5, 148.7), 52 (54%) of patients had been reclassified or demonstrated disease progression. The median progression-free and overall survival for the cohort were 68.7 (95%CI: 53.2, 97.3) months and 156.9 (95%CI: 139.9, 161.5) months, respectively. Only one prostate cancer specific mortality was identified. Conclusions: AS presents a reasonable management strategy option for low-risk prostate cancer in appropriately selected patients. However, treatment at time of disease progression did not improve survival. A significant percentage of men on AS are exposed to progression of their disease if alive beyond 10 years from their diagnosis.