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

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.

Automated summary

Active surveillance (AS) is a feasible option for low-risk prostate cancer patients, with a small portion ultimately discontinuing surveillance for various reasons. In carefully selected patients, AS is still able to significantly reduce biochemical recurrence rates. Further larger prospective studies are necessary to determine optimal criteria for AS, especially in Korean prostate cancer patients.