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KMID : 1011820210620010032
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Investigative and Clinical Urology
2021 Volume.62 No. 1 p.32 ~ p.38
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A single-center long-term experience of active surveillance for prostate cancer: 15 years of follow-up
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Song Sang-Hun
Kim Jung-Kwon
Lee Hak-Min
Lee Sang-Chul
Hong Sung-Kyu
Byun Seok-Soo
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Abstract
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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.
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KEYWORD
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Patient selection, Prostatic neoplasms, Watchful waiting
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