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KMID : 1011820170580030164
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Investigative and Clinical Urology
2017 Volume.58 No. 3 p.164 ~ p.170
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Updated clinical results of active surveillance of very-low-risk prostate cancer in Korean men: 8 years of follow-up
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Ha Ji-Yong
Shin Teak-Jun
Jung Won-Ho
Kim Byung-Hoon
Park Choal-Hee
Kim Chun-Il
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Abstract
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Purpose: Update and reanalysis of our experience of active surveillance (AS) for prostate cancer (PCa) in Korea.
Materials and Methods: A prospective, single-arm, cohort study was initiated in January 2008. Patients were selected according to the following criteria: Gleason sum ≤6 with single positive core with ≤30% core involvement, clinical stage≤T1c, prostate-specific antigen (PSA)≤10 ng/mL, and negative magnetic resonance imaging (MRI) results. Follow-up was by PSA measurement every 6 months, prostate biopsies at 1 year and then every 2?3 years, and MRI every year.
Results: A total of 80 patients were treated with AS. Median follow-up was 52 months (range, 6?96 months). Of them, 39 patients (48.8%) discontinued AS for various reasons (17, disease progression; 9, patient preference; 10, watchful waiting due to old age; 3, follow-up loss; 2, death). The probability of progression was 14.0% and 42.9% at 1 and 3 years, respectively. Overall survival was 97.5%. PCa-specific survival was 100%. Progression occurred in 5 of 7 patients (71.4%) with a prostate volume less than 30 mL, 7 of 40 patients (17.5%) with a prostate volume of 30 to 50 mL, and 5 of 33 patients (15.2%) with a prostate volume of 50 mL or larger. There were 8 detectable positive lesions on follow-up MRI. Of them, 6 patients (75%) had actual progressed disease.
Conclusions: Small prostate volume was associated with a tendency for cancer progression. MRI was helpful and promising for managing AS. Nevertheless, regular biopsies should be performed. AS is a safe and feasible treatment option for very-low-risk PCa in Korea. However, AS should continue to be used in carefully selected patients.
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KEYWORD
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Needle biopsy, Prostate-specific antigen, Prostatic neoplasms, Watchful waiting
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