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

Sang Hun Song, Jung Kwon Kim, Hakmin Lee, Sangchul Lee, Sung Kyu Hong, Seok Soo Byun

Research output: Contribution to journalArticlepeer-review

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 fifty-three 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.

Original languageEnglish
Pages (from-to)32-38
Number of pages7
JournalInvestigative and clinical urology
Volume62
Issue number1
DOIs
StatePublished - Jan 2021
Externally publishedYes

Keywords

  • Patient selection
  • Prostatic neoplasms
  • Watchful waiting

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