MP42-04 ACTIVE SURVEILLANCE: WHEN CAN PATIENTS STOP WORRYING?

Abstract

You have accessJournal of UrologyProstate Cancer: Localized I1 Apr 2015MP42-04 ACTIVE SURVEILLANCE: WHEN CAN PATIENTS STOP WORRYING? Ridwan Alam, H. Ballentine Carter, Patricia Landis, Jonathan I. Epstein, and Mufaddal Mamawala Ridwan AlamRidwan Alam More articles by this author , H. Ballentine CarterH. Ballentine Carter More articles by this author , Patricia LandisPatricia Landis More articles by this author , Jonathan I. EpsteinJonathan I. Epstein More articles by this author , and Mufaddal MamawalaMufaddal Mamawala More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2015.02.1589AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Active surveillance of prostate cancer has become an accepted alternative to immediate intervention for patients with favorable risk prostate cancer. However, there is still concern over the risk of cancer progression or misclassification due to biopsy sampling error. In this study, we sought to evaluate the risk of prostate cancer reclassification over time in active surveillance. METHODS From 1995 to 2014, 808 men (557 very-low-risk and 251 low-risk) on active surveillance who were compliant with prostate biopsies were evaluated for the primary outcome of reclassification to worse disease by grade or extent. Freedom from reclassification was estimated using the Kaplan-Meier approach with adjustment for covariates using a Cox proportional hazards model. RESULTS Within the first two years of surveillance, the survival free of reclassification by grade (P = 0.20) and any biopsy criteria (P = 0.25) were similar between men with very-low-risk and low-risk disease. After two years, men with low-risk disease were 2.4 times more likely to be diagnosed with a Gleason score above 6 as compared to men with very-low-risk disease (P = 0.002, HR = 2.4, 95% CI = 1.9-3.5) [Figure 1]. Additionally, beyond two years in surveillance, the risk of lifetime reclassification by grade and any criteria decreased by 30% (P < 0.0001, HR = 0.70, 95% CI = 0.60-0.76) [Figure 2] and 35% (P < 0.0001, HR = 0.65, 95% CI = 0.57-0.72), respectively, with each biopsy showing no reclassification. CONCLUSIONS The rate of reclassification during surveillance is not equally distributed across time or risk groups. Due to misclassification at the time of diagnosis, the rates of reclassification between very-low-risk and low-risk groups are similar within the first two years but differ significantly beyond two years. Reclassification risk falls over time with each biopsy that did not show reclassification after two years. Therefore, men in active surveillance who are compliant with their annual biopsies can be reassured that their risk of lifetime reclassification declines with each non-reclassifying biopsy after two years. © 2015 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 193Issue 4SApril 2015Page: e509 Advertisement Copyright & Permissions© 2015 by American Urological Association Education and Research, Inc.MetricsAuthor Information Ridwan Alam More articles by this author H. Ballentine Carter More articles by this author Patricia Landis More articles by this author Jonathan I. Epstein More articles by this author Mufaddal Mamawala More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...