Abstract
Purpose. Active surveillance is an emergent strategy for management of indolent prostate cancer. Our institution's watchful waiting protocol, Active Holistic Surveillance (AHS), implements close monitoring for disease progression along with various chemopreventive agents and attempts to reduce unnecessary biopsies. Our objective is to report on the treatment rates of men on our AHS protocol as well as determine reasons for progression. Materials/Methods. Low risk and low-intermediate risk patients were enrolled in AHS at Winthrop University Hospital between February 2002 and August 2015. Our IRB-approved study analyzed survival rate, discontinuation rates, and definitive treatments for patients in our AHS cohort. Results. 235 patients met inclusion criteria. Median age and follow-up for the cohort were 66 (44–88) years and 42 (3–166) months, respectively. The overall survival for the cohort was 99.6% and the disease specific survival was 100%. A total of 27 (11.5%) patients discontinued AHS. Conclusion. The incorporation of chemopreventive agents in our AHS protocol has allowed patients to prolong definitive treatment for many years. Longer follow-up and additional studies are necessary to further validate the effectiveness of AHS.
Highlights
Prostate cancer is the second most commonly diagnosed cancer amongst American men [1]
Clinicians found it necessary to develop an approach that embraced the concept of watchful waiting for low risk patients to prolong and possibly avoid definitive treatment [4]
The secondary outcomes included the reason for discontinuation and definitive treatments following Active Holistic Surveillance (AHS)
Summary
Prostate cancer is the second most commonly diagnosed cancer amongst American men [1]. Treatment of low risk prostate cancer remains unclear. As of July 2008, Cancer of the Prostate Strategic Urologic Research Endeavor (CaPSURE) reported that 95% of prostate cancer patients were receiving definitive treatment, even with most patients having lowgrade disease [2]. Definitive treatment causes several side effects for patients, including incontinence, erectile dysfunction, and bowel complications [3]. Many of these early detected cancers tend to be more indolent than life threatening, and often treatment of this nonlethal disease represents overtreatment. Clinicians found it necessary to develop an approach that embraced the concept of watchful waiting for low risk patients to prolong and possibly avoid definitive treatment [4]
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