Open AccessFive-year follow-up of active surveillance for prostate cancer: A Canadian community-based urological experience
Author(s) -
James Andrews,
James E. Ashfield,
Michael A. Morse,
Thomas F. Whelan
Publication year - 2014
Publication title -
canadian urological association journal
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.477
H-Index - 38
eISSN - 1920-1214
pISSN - 1911-6470
DOI - 10.5489/cuaj.2186
Subject(s) - medicine , prostate cancer , hazard ratio , biopsy , cohort , proportional hazards model , confidence interval , prostate specific antigen , watchful waiting , retrospective cohort study , prostate , cancer , prostate biopsy
We assessed oncological outcomes of active surveillance (AS) using a community database and identified factors associated with disease reclassification on surveillance biopsy.Methods: A retrospective review was performed on 200 men on AS. Prostate-specific antigen (PSA) was measured every 3 to 6 months. Prostate biopsies were performed every 1 to 4 years, and at the individual physician’s discretion. Disease reclassification was defined as clinical T1 to cT2 progression, or histologically as >2 cores positive, Gleason score >6, or >50% core involvement on surveillance biopsy. Multivariate Cox regression analysis evaluated factors associated with disease reclassification. Kaplan-Meier survival curves were plotted.Results: We assessed a heterogeneous cohort of 86 patients, with a median age 67.2 years, who received ≥1 surveillance biopsies. The median follow-up was 5.2 years. The median times to first and second surveillance biopsies were 730 and 763 days, respectively. Overall, 47% of patients were reclassified on surveillance biopsy after a median 2.1 years. Factors associated with disease reclassification were PSA density >0.20 (p 0.20 and ≥3 cores positive are associated with disease reclassification on surveillance biopsy.