Active surveillance for localized prostate cancer: update of a prospective single-center cohort

Abstract

Objective: The purpose of active surveillance (AS) is to reduce overtreatment of men with localized prostate cancer (PCa) without compromising survival. The objective of this study was to update a large Scandinavian single-center AS cohort. Furthermore, the use of curative treatment and subsequent risk of biochemical recurrence were investigated and compared in men with very low-risk, low-risk and intermediate-risk PCa in the cohort.

Materials and methods: In total, 451 men were followed on AS and monitored with prostate-specific antigen (PSA) tests, digital rectal examinations and rebiopsies. Recommendation of curative treatment was based on protocolled and predefined risk of progression criteria. Biochemical recurrence was defined as PSA ≥0.2 ng/ml after radical prostatectomy and PSA nadir +2 ng/ml after radiotherapy.

Results: Altogether, 34% were defined with very low-risk PCa, 40% with low-risk PCa and 24% with intermediate-risk PCa. The median follow-up was 5.1 years. The estimated 5 year curatively intended treatment-free survival was 60.5% [95% confidence interval (CI) 54.8–66.2%], with no statistically significant difference between men with very low-risk, low-risk or intermediate-risk PCa. The 5 year biochemical recurrence-free survival was 92.3% (95% CI 87.4–97.2), again with no difference between men with very low-risk, low-risk and intermediate-risk PCa.

Conclusion: AS for very low- to low-risk localized PCa is feasible and safe within the short to intermediate time frame. Men with intermediate-risk PCa had the same risk of undergoing curative treatment as men with low-risk PCa, without compromising biochemical recurrence-free survival.

Keywords:

• Active surveillance
• biochemical recurrence
• curative treatment
• intermediate risk
• low risk
• prostate cancer
• treatment-free survival
• very low risk

Acknowledgements

The first author would like to thank the entire staff of Copenhagen Prostate Cancer Center at the Department of Urology, Rigshospitalet, University of Copenhagen, for support during the process of conducting this study and writing this paper.

Disclosure statement

The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the paper.