MP45-02 13 YEARS OF EXPERIENCE IN ACTIVE SURVEILLANCE FOR PROSTATE CANCER: MALCOMPLIANCE IS A MAJOR CONCERN IN THE LONG TERM

Abstract

You have accessJournal of UrologyProstate Cancer: Localized III1 Apr 2014MP45-02 13 YEARS OF EXPERIENCE IN ACTIVE SURVEILLANCE FOR PROSTATE CANCER: MALCOMPLIANCE IS A MAJOR CONCERN IN THE LONG TERM Lukas Hefermehl, Daniel Disteldorf, Scherwin Talimi, Rachel Groebli, Benjamin Lyttwin, and Kurt Lehmann Lukas HefermehlLukas Hefermehl More articles by this author , Daniel DisteldorfDaniel Disteldorf More articles by this author , Scherwin TalimiScherwin Talimi More articles by this author , Rachel GroebliRachel Groebli More articles by this author , Benjamin LyttwinBenjamin Lyttwin More articles by this author , and Kurt LehmannKurt Lehmann More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2014.02.1199AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail Introduction and Objectives Active Surveillance (AS) has become a standard treatment for a defined group of patients. Clinical parameters have been approved in similar protocols at large academic institutions. However, non-clinical parameters such as patient compliance are underrated but crucial parameters, especially in a form of therapy where continuous follow up (FU) is imperative. Furthermore, long term data for AS are still not well known, especially in a community hospital environment. Methods We conducted a prospective study starting in 1999 at our non-academic institution. Inclusion and progression criteria as well as FU schedule met general recommendations for AS. If patients failed to appear they were contacted at least twice by post explaining the importance of FU. Results 157 men have been included at a median age of 67 (61-70) y between 1999 and 2013. Median FU was 36 (24-72) mo 32 (20%) men showed progression after a median FU of 26 (19-35) mo. Progression free survival (PFS) was 65% in 146mo. Of these 32 men 62% underwent radical prostatectomy (RP) and 34% had external beam radiotherapy (EBRT). 1 man required direct androgen deprivation therapy and died consecutively. After RP 37% showed GS 7, 5% GS 8 & 10% GS 9. FU after RP was 52 (12-76) & 21 (15-51)mo after EBRT. Follow-up with no evidence of disease after treatment in these men was 43 (12-71) & 23 (15-50) mo respectively. 2nd line therapy was needed only in 1 man after RP and 1 after EBRT. 13-y Kaplan-Meier analysis revealed an estimated progression rate of 28%, lost to FU rate of 27%, OS of 94%, CSS of 99% and PFS of 98%. After 13y only 50% remained in the AS group. 17 (11%) men were lost to FU. Overall drop-out was 36% (57). According to the protocol median FU would have been 67 (43-118) mo. Due to malcompliance actual FU was 36 (24-72) mo only. 3 mo after diagnosis 19% refused confirmation biopsy. Scheduled number of PSA measurements was 1891 but only 40% were performed. Conclusions Even in a community hospital environment AS seams safe if the protocol is followed. Secondary progression after treatment is low. However, in nearly 1/3 histology after RP revealed an aggressive tumor. After 13y ¼ of all men will need definitive treatment and only ½ will continue AS. Lost to FU rate is considerable. When AS is commenced the problem of malcompliance is often scotomized. Stable disease leads to protocol violation and even complete lost to FU in some men. However, our responsibility remains. Our 13y experience reveals that malcompliance is a major concern: This needs to be taken in consideration for future AS protocols and whenever AS is offered as a treatment option. © 2014FiguresReferencesRelatedDetails Volume 191Issue 4SApril 2014Page: e459-e460 Advertisement Copyright & Permissions© 2014MetricsAuthor Information Lukas Hefermehl More articles by this author Daniel Disteldorf More articles by this author Scherwin Talimi More articles by this author Rachel Groebli More articles by this author Benjamin Lyttwin More articles by this author Kurt Lehmann More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...