MP15-16 OUTCOMES AND FACTORS CHANGING TO INTERVENTION IN ACTIVE SURVEILLANCE FOR LOCALIZED PROSTATE CANCER: SYSTEMATIC REVIEW AND META-ANALYSIS OF CONTEMPORARY SERIES

Abstract

You have accessJournal of UrologyProstate Cancer: Localized: Active Surveillance II1 Apr 2016MP15-16 OUTCOMES AND FACTORS CHANGING TO INTERVENTION IN ACTIVE SURVEILLANCE FOR LOCALIZED PROSTATE CANCER: SYSTEMATIC REVIEW AND META-ANALYSIS OF CONTEMPORARY SERIES Ahmed Aboumohamed, Ilir Agalliu, and Reza Ghavamian Ahmed AboumohamedAhmed Aboumohamed More articles by this author , Ilir AgalliuIlir Agalliu More articles by this author , and Reza GhavamianReza Ghavamian More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2016.02.2540AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Active surveillance (AS) is an increasingly utilized treatment modality for patients with localized prostate cancer. Outcomes and factors changing to active treatment vary among different series reporting on AS. A systematic review of the evidence about AS was undertaken, with meta-analysis to identify outcomes and factors changing to active treatment. METHODS We performed Medline and EMBASE literature search to identify studies on AS from 2005 to October 2015. A systematic review was performed using Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. We extracted eligibility criteria, age, PSA, surveillance protocol, sample size, follow-up duration, treatment change triggers, treatment change rates, metastasis, and cancer-specific deaths. The meta-analysis was done with the random effects model in STATA using the ′metan′ command. We plotted forest plots of the hazard ratio (HR) and 95% confidence interval (CI) for each study as well as the pooled random effect HR for the overall effect. Heterogeneity across studies was examined by calculating the i2 statistic. RESULTS A total of 24 AS series comprising 9920 patients were included. Median age was 65.9 years, median PSA was 5.1 ng/dL, and median follow-up was 3.3 years (range 1.5-6.4). Marked heterogeneity was noted among the studies in their inclusion criteria, surveillance protocols, and triggers for intervention. There were 21 prostate cancer deaths and 42 metastases in 38 311 person-years of follow-up; however, when series including patients with Gleason 7 were excluded, there were 6 and 14, respectively, in 21 182 person-years of follow-up. Overall, 24.6% received active treatment with overall pooled HR 0.25 (95% CI 0.24-0.26), with 20.2% were treated due to patient preference/ anxiety. Other factors for conversion to active treatment included pathologic reclassification (Gleason upgrade and/or volume progression); overall pooled HR 0.19 (95% CI 0.17-0.21), or PSA progression; overall pooled HR 0.03 (95% CI 0.02-0.04). Less common triggers included MRI progression or local symptomatic progression. CONCLUSIONS Marked heterogeneity among AS series makes firm conclusions difficult. There was remarkable increased risk of metastasis and cancer death in studies including patients with Gleason 7. Significant proportion was treated due to patient preference triggered by anxiety with no signs of disease progression. There is a strong need for a robust evidence from prospective trials with longer follow-up. © 2016FiguresReferencesRelatedDetails Volume 195Issue 4SApril 2016Page: e157-e158 Advertisement Copyright & Permissions© 2016MetricsAuthor Information Ahmed Aboumohamed More articles by this author Ilir Agalliu More articles by this author Reza Ghavamian More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...