PD14-03 LONG TERM FOLLOW-UP OF A LARGE ACTIVE SURVEILLANCE COHORT

Abstract

You have accessJournal of UrologyProstate Cancer: Localized II1 Apr 2014PD14-03 LONG TERM FOLLOW-UP OF A LARGE ACTIVE SURVEILLANCE COHORT Laurence Klotz, Danny Vesprini, and Andrew Loblaw Laurence KlotzLaurence Klotz More articles by this author , Danny VespriniDanny Vesprini More articles by this author , and Andrew LoblawAndrew Loblaw More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2014.02.1280AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Active surveillance has been increasingly accepted as a treatment option for favorable risk prostate cancer. Lack of long term follow up has been a limitation of the data to date. OBJECTIVE To determine the long term outcome of an active surveillance protocol in men with favorable risk prostate cancer METHODS Setting: Single center academic health sciences centre. PARTICIPANTS Referred sample of 840 men with favorable or intermediate risk prostate cancer selecting active surveillance. Intervention: A prospective single arm cohort study. Patients selecting active surveillance were managed with an initial expectant approach. Intervention was offered to those patients with a PSA doubling time of < 3 years, Gleason score progression (to 4+3 or greater), or unequivocal clinical progression. Main outcome measures: Overall and disease specific survival, rate of treatment, and PSA failure rate in the treated patients. RESULTS 147/840 (17.5%) patients died and 693 patients are alive (censored rate 82.5%). There were 14 (1.7%) deaths from prostate. The 10, 15, and 20 year actuarial CSS was 97.9%, 93.5%, and 86.3%. All 14 patients who died of prostate cancer had confirmed metastases prior to death. An additional 16 patients (1.9%) are alive with confirmed metastases (14 to bone and 2 to liver). Thus. At 5, 10, 15 and 20 years, 77.1%, 63.4% and 52.3%, and 52.3% of patients remain untreated and on surveillance. Of the 208 patients who were treated, 44 (21%) or 5% of the overall cohort experienced PSA/biochemical failure (BF). BF occurred in 11% of the surgery patients and 22% of the radiation patients. The cumulative hazard ratio for non-prostate to prostate cancer mortality was 9.7:1. CONCLUSIONS Active surveillance for favorable risk prostate cancer is feasible and appears safe in the 15-20 year time frame. In this cohort, the likelihood of dying of other causes was 9.7 times greater than the likelihood of prostate cancer death. While prostate cancer mortality increased with longer follow up, only 3.6% of patients have developed metastatic disease and 1.7% of died of prostate cancer. This figure is consistent with expected mortality in favorable risk patients managed with initial definitive intervention. © 2014FiguresReferencesRelatedDetailsCited byWelty C, Cowan J, Nguyen H, Shinohara K, Perez N, Greene K, Chan J, Meng M, Simko J, Cooperberg M and Carroll P (2018) Extended Followup and Risk Factors for Disease Reclassification in a Large Active Surveillance Cohort for Localized Prostate CancerJournal of Urology, VOL. 193, NO. 3, (807-811), Online publication date: 1-Mar-2015. Volume 191Issue 4SApril 2014Page: e411-e412 Advertisement Copyright & Permissions© 2014MetricsAuthor Information Laurence Klotz More articles by this author Danny Vesprini More articles by this author Andrew Loblaw More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...