Investig Clin Urol.  2017 May;58(3):164-170. 10.4111/icu.2017.58.3.164.

Updated clinical results of active surveillance of very-low-risk prostate cancer in Korean men: 8 years of follow-up

• Ha JY
• Shin TJ
• Jung W
• Kim BH
• Park CH
• Kim CI

• KMID: 2388060
• DOI: http://doi.org/10.4111/icu.2017.58.3.164

Abstract

PURPOSE
Update and reanalysis of our experience of active surveillance (AS) for prostate cancer (PCa) in Korea.
MATERIALS AND METHODS
A prospective, single-arm, cohort study was initiated in January 2008. Patients were selected according to the following criteria: Gleason sum ≤6 with single positive core with ≤30% core involvement, clinical stage≤T1c, prostate-specific antigen (PSA)≤10 ng/mL, and negative magnetic resonance imaging (MRI) results. Follow-up was by PSA measurement every 6 months, prostate biopsies at 1 year and then every 2-3 years, and MRI every year.
RESULTS
A total of 80 patients were treated with AS. Median follow-up was 52 months (range, 6-96 months). Of them, 39 patients (48.8%) discontinued AS for various reasons (17, disease progression; 9, patient preference; 10, watchful waiting due to old age; 3, follow-up loss; 2, death). The probability of progression was 14.0% and 42.9% at 1 and 3 years, respectively. Overall survival was 97.5%. PCa-specific survival was 100%. Progression occurred in 5 of 7 patients (71.4%) with a prostate volume less than 30 mL, 7 of 40 patients (17.5%) with a prostate volume of 30 to 50 mL, and 5 of 33 patients (15.2%) with a prostate volume of 50 mL or larger. There were 8 detectable positive lesions on follow-up MRI. Of them, 6 patients (75%) had actual progressed disease.
CONCLUSIONS
Small prostate volume was associated with a tendency for cancer progression. MRI was helpful and promising for managing AS. Nevertheless, regular biopsies should be performed. AS is a safe and feasible treatment option for very-low-risk PCa in Korea. However, AS should continue to be used in carefully selected patients.

Keyword

Needle biopsy; Prostate-specific antigen; Prostatic neoplasms; Watchful waiting

MeSH Terms

Biopsy
Biopsy, Needle
Cohort Studies
Disease Progression
Follow-Up Studies*
Humans
Korea
Magnetic Resonance Imaging
Male
Passive Cutaneous Anaphylaxis
Patient Preference
Prospective Studies
Prostate*
Prostate-Specific Antigen
Prostatic Neoplasms*
Watchful Waiting
Prostate-Specific Antigen

Figure

• 

  Fig. 1 Flow chart of active surveillance. AS, active surveillance; F/U, follow-up; RP, radical prostatectomy; HT, hormone therapy; T/F, transfer; WW, watchful waiting.

• 

  Fig. 2 Progression-free survival for prostate volume. Group 1, prostate volume<30 mL; group 2, prostate volume 30 to 50 mL; group 3, prostate volume≥50 mL.

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