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. 2020 Jun;203(6):1122-1127.
doi: 10.1097/JU.0000000000000713. Epub 2019 Dec 23.

Long-Term Outcomes of Active Surveillance for Prostate Cancer: The Memorial Sloan Kettering Cancer Center Experience

Sigrid Carlsson  1   2   3 , Nicole Benfante  1 , Ricardo Alvim  1 , Daniel D Sjoberg  2 , Andrew Vickers  2 , Victor E Reuter  4 , Samson W Fine  4 , Hebert Alberto Vargas  5 , Michal Wiseman  1 , Maha Mamoor  1 , Behfar Ehdaie  1 , Vincent Laudone  1 , Peter Scardino  1 , James Eastham  1 , Karim Touijer  1
Affiliations

Long-Term Outcomes of Active Surveillance for Prostate Cancer: The Memorial Sloan Kettering Cancer Center Experience

Sigrid Carlsson et al. J Urol. 2020 Jun.

Abstract

Purpose: We report oncologic outcomes for men with Grade Group 1 prostate cancer managed with active surveillance at a tertiary cancer center.

Materials and methods: A total of 2,907 patients were managed with active surveillance between 2000 and 2017, of whom 2,664 had Grade Group 1 disease. Patients were recommended confirmatory biopsy to verify eligibility and were followed semiannually with prostate specific antigen, digital rectal examination and review of symptoms. Magnetic resonance imaging was increasingly used in recent years. Biopsy was repeated every 2 to 3 years or after a sustained prostate specific antigen increase or changes in magnetic resonance imaging/digital rectal examination. The Kaplan-Meier method was used to estimate probabilities of treatment, progression and development of metastasis.

Results: Median patient age at diagnosis was 62 years. For men with Grade Group 1 prostate cancer the treatment-free probability at 5, 10 and 15 years was 76% (95% CI 74-78), 64% (95% CI 61-68) and 58% (95% CI 51-64), respectively. At 5, 10 and 15 years there were 1,146, 220 and 25 men at risk for metastasis, respectively. Median followup for those without metastasis was 4.3 years (95% CI 2.3-6.9). Distant metastasis developed in 5 men. Upon case note review only 2 of these men were deemed to have disease that could have been cured on immediate treatment. The risk of distant metastasis was 0.6% (95% CI 0.2-2.0) at 10 years.

Conclusions: Active surveillance is a safe strategy over longer followup for appropriately selected patients with Grade Group 1 disease following a well-defined monitoring plan.

Keywords: prostatic neoplasms; watchful waiting.

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Conflict of interest statement

Conflict of interest: Sigrid Carlsson has received a lecture honorarium and travel support from Astellas Pharma (unrelated to current study). Andrew Vickers is named on a patent for a statistical method to detect prostate cancer that has been commercialized by OPKO Health. Andrew Vickers receives royalties from sales of the test and has stock options in OPKO Health.

Figures

Figure 1.
Figure 1.. Risk of treatment and grade progression among Grade Group 1 patients
Dashed blue line represents risk of grade progression and solid orange line represents risk of treatment.
Figure 2.
Figure 2.. Age and risk of non-organ confined disease at diagnosis over time for men with Grade Group 1
The blue line with the short-dash confidence interval represents the change in age at diagnosis over time. The orange line with long-dash confidence interval represents the change in risk of non-organ confined disease at diagnosis over time.
See this image and copyright information in PMC

Comment in

References

    1. Moschini M, Carroll PR, Eggener SE et al.: Low-risk Prostate Cancer: Identification, Management, and Outcomes. Eur Urol, 72: 238, 2017 - PubMed
    1. Wilt TJ, Andriole GL, Brawer MK: Prostatectomy versus Observation for Early Prostate Cancer. N Engl J Med, 377: 1302, 2017 - PubMed
    1. Hamdy FC, Donovan JL, Lane JA et al.: 10-Year Outcomes after Monitoring, Surgery, or Radiotherapy for Localized Prostate Cancer. N Engl J Med, 375: 1415, 2016 - PubMed
    1. Bill-Axelson A, Holmberg L, Garmo H. et al.: Radical prostatectomy or watchful waiting in early prostate cancer. N Engl J Med, 370: 932, 2014 - PMC - PubMed
    1. Choo R, Klotz L, Danjoux C. et al.: Feasibility study: watchful waiting for localized low to intermediate grade prostate carcinoma with selective delayed intervention based on prostate specific antigen, histological and/or clinical progression. J Urol, 167: 1664, 2002 - PubMed

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