PD12-03 ACTIVE SURVEILLANCE IN 853 MEN WITH LOW AND INTERMEDIATE RISK PROSTATE CANCER

Abstract

You have accessJournal of UrologyProstate Cancer: Localized I1 Apr 2014PD12-03 ACTIVE SURVEILLANCE IN 853 MEN WITH LOW AND INTERMEDIATE RISK PROSTATE CANCER Jonathan Aning, Michael Peacock, Homi Zargar, David Harriman, Michael McKenzie, Peter Black, Alan So, Larry Goldenberg, and Martin Gleave Jonathan AningJonathan Aning More articles by this author , Michael PeacockMichael Peacock More articles by this author , Homi ZargarHomi Zargar More articles by this author , David HarrimanDavid Harriman More articles by this author , Michael McKenzieMichael McKenzie More articles by this author , Peter BlackPeter Black More articles by this author , Alan SoAlan So More articles by this author , Larry GoldenbergLarry Goldenberg More articles by this author , and Martin GleaveMartin Gleave More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2014.02.975AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Active surveillance (AS) is gaining increasing acceptance as an alternative primary treatment option to curative therapy in men with ‘low risk’ organ confined prostate cancer. The aim of this study was to evaluate short and medium term outcomes of a large cohort of men from a single institution with low and intermediate risk prostate cancer managed with AS and to identify risk factors predicting for progression. METHODS All men managed with AS as a primary therapy were identified from a prospectively maintained institutional database. All men were less than 75 years old, had undergone restaging prostate biopsy and had at least 6 months follow up. AS involved 6 monthly PSA and DRE reviews in addition to rebiopsy of the prostate, with planned repeat biopsies every 2 years. Prostate cancer risk status was defined by National Comprehensive Cancer Network guideline criteria. Kaplein–Meier and Cox logistic regression were applied to estimate survival and risk factors of progression for the whole cohort. RESULTS In total 853 men with a mean age of 65 years and mean PSA at diagnosis of 6.5ng/ml met inclusion criteria. Mean follow up was 5 years. Of the cohort 50%, 27% and 23% were classified as very low, low or intermediate risk prostate cancer, respectively. Progression to active treatment occurred in 309 patients, most commonly due to grade progression at re-biopsy (62%), while patient choice and PSA progression accounted for 10% and 8% respectively. Actuarial probability of remaining on AS for the whole cohort at 1, 2, 5, 8 years was 95%, 81%, 60%, 47% respectively. There was a significant difference in the risk of progression to treatment between very low risk and other groups (p = 0.002), but not between low and intermediate risk groups (p= 0.481). Multivariate analysis determined increasing number of positive biopsy cores at diagnosis and PSA density as significant predictors of progression to treatment (p= <0.001). Negative prostate biopsies prior to diagnosis was a significant negative predictor of progression to treatment (p=0.01). Of those treated 4% (n=15) had biochemical recurrence. Overall survival of the cohort was 97% and only 1 patient died of prostate cancer. CONCLUSIONS AS has the lowest risk of progression in very low risk prostate cancer, and is also an acceptable mode of initial treatment in selected men with low and low-tier intermediate risk prostate cancer. Further studies should be directed specifically at the low and intermediate risk groups to better risk stratify who needs intervention. © 2014FiguresReferencesRelatedDetails Volume 191Issue 4SApril 2014Page: e347 Advertisement Copyright & Permissions© 2014MetricsAuthor Information Jonathan Aning More articles by this author Michael Peacock More articles by this author Homi Zargar More articles by this author David Harriman More articles by this author Michael McKenzie More articles by this author Peter Black More articles by this author Alan So More articles by this author Larry Goldenberg More articles by this author Martin Gleave More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...