Five-year follow-up of active surveillance for prostate cancer: A Canadian community-based urological experience

Authors

  • J. Matthew J. Andrews Dalhousie University
  • James E. Ashfield Dalhousie University
  • Michael Morse Dalhousie University
  • Thomas F. Whelan Dalhousie University

DOI:

https://doi.org/10.5489/cuaj.2186

Keywords:

prostate, prostate cancer, active surveillance

Abstract

Introduction: 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 < 0.0001, hazard ratio [HR] 4.55, 95% confidence interval [CI] 2.116–9.782) and ≥3 positive cores (p = 0.0152, HR 3.956, 95% CI 1.304–12.003) at diagnosis, and number of positive cores on surveillance biopsy. In total, 25 (29%) patients received delayed intervention, with a median time to intervention of 2.6 years. The median time on AS was 4.4 years, with an overall survival of 95% and prostate-specific survival of 100%.

Conclusions: Our community study supports AS to reduce over treatmentof prostate cancer. PSA density >0.20 and ≥3 cores positive are associated with disease reclassification on surveillance biopsy.

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Author Biographies

J. Matthew J. Andrews, Dalhousie University

Department of Urology, Halifax, Nova Scotia

James E. Ashfield, Dalhousie University

Department of Urology, Saint John, New Brunswick

Michael Morse, Dalhousie University

Department of Urology, Saint John, New Brunswick

Thomas F. Whelan, Dalhousie University

Department of Urology, Saint John, New Brunswick

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Published

2014-11-24

How to Cite

Andrews, J. M. J., Ashfield, J. E., Morse, M., & Whelan, T. F. (2014). Five-year follow-up of active surveillance for prostate cancer: A Canadian community-based urological experience. Canadian Urological Association Journal, 8(11-12), e768–74. https://doi.org/10.5489/cuaj.2186

Issue

Section

Original Research