Investig Clin Urol.  2021 Jan;62(1):32-38. 10.4111/icu.20200206.

A single-center long-term experience of active surveillance for prostate cancer: 15 years of follow-up

Affiliations
  • 1Department of Urology, Seoul National University Bundang Hospital, Seongnam, Korea.
  • 2Department of Urology, Seoul National University College of Medicine, Seoul, Korea

Abstract

Purpose
To describe a single-center 15-year experience of active surveillance (AS) for prostate cancer (PCa).
Materials and Methods
We retrospectively reviewed patients who underwent AS between 2003 and 2018. One hundred fiftythree patients were selected according to the following criteria: (1) biopsy Gleason pattern ≤3+4 with (2) ≤two positive core(s) and (3) ≤50% core involvement, clinical-stage ≤T2a, and prostate-specific antigen (PSA) ≤20 ng/mL. Follow-up included PSA measurement every six months, prostate biopsies at one year and then every 2–3 years, and MRI every year. Intervention was triggered by (1) Gleason score (GS) upgrading, (2) >two positive cores, or (3) PSA doubling-time in <3 years.
Results
Mean (±standard deviation) follow-up was 36.4 (±31.9) months. Ninety-three (60.8%) and 20 (13.1%) patients received second and third biopsies, respectively. Seventy-two patients (47.1%) discontinued AS for various reasons (59, intervention; 13, follow-up loss). Reasons for intervention consisted of GS upgrading (42.4%), >two positive cores (8.5%), abnormal PSA kinetics (11.9%), and patient preference (37.3%). Notably, 12 (25.5%) patients had pathologic GS ≥4+3 (unfavorable disease) and 3 (6.4%) patients had pathologic stage ≥T3a at radical prostatectomy. Median time to treatment-free survival was 19.5 months. Of the 59 patients who switched to intervention, biochemical recurrence was reported in only one (0.7%) patient.
Conclusions
AS is an available option for low-risk PCa in carefully selected patients. Further larger prospective studies are needed to determine the optimal criteria for AS, especially in Korean PCa patients.

Keyword

Patient selection; Prostatic neoplasms; Watchful waiting
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