title: Active surveillance for prostate cancers detected in three subsequent rounds of a screening trial: characteristics, PSA doubling times, and outcome.
abstract: OBJECTIVE
  To study active surveillance as a management option for the important number of prostate cancer patients who would not have been diagnosed in the absence of screening.
  
  
  METHODS
  We analyzed baseline characteristics and outcome parameters of all men on active surveillance who were screen-detected in the Rotterdam section of the European Randomized Study of Screening for Prostate Cancer (ERSPC). Recruitment and surveillance of men were not guided by a protocol but depended on individual decisions of patients and their physicians.
  
  
  RESULTS
  Active surveillance was applied in 278 men detected by screening from 1993 to 2006. At diagnosis, their median age was 69.8 yr (25-75p; 66.1-72.8); median PSA 3.6 ng/ml (25-75p; 3.1-4.8), and the clinical stage was T1c in 220 (79.1%) and T2 in 58 (20.9%). During the follow-up of median 3.4 yr, 103 men (44.2%) had a PSA doubling time that was negative (ie, half-life) or longer than 10 yr. Men detected at rescreening were significantly more likely to be on active surveillance, and they had more beneficial characteristics. Deferred treatment was elected in 82 cases (29.0%). Overall survival was 89% after 8 yr; the cause-specific survival was 100%.
  
  
  CONCLUSIONS
  This report shows a beneficial, although preliminary, outcome of screen-detected men managed on active surveillance. Men were more likely to be on active surveillance if the disease was detected at repeated screening. The report also shows that an important proportion of men have prolonged PSA doubling times, although the value of this parameter has not been established in untreated men.
authors.affiliation: Department of Urology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands.
authors.forename: Stijn
authors.initials: S
authors.lastname: Roemeling
authors.forename: Monique J
authors.initials: MJ
authors.lastname: Roobol
authors.forename: Stijn H
authors.initials: SH
authors.lastname: de Vries
authors.forename: Tineke
authors.initials: T
authors.lastname: Wolters
authors.forename: Claartje
authors.initials: C
authors.lastname: Gosselaar
authors.forename: Geert J L H
authors.initials: GJ
authors.lastname: van Leenders
authors.forename: Fritz H
authors.initials: FH
authors.lastname: Schröder
mesh_terms: D000328:Adult; D000368:Aged; D018572:Disease-Free Survival; D006801:Humans; D008297:Male; D008403:Mass Screening; D008875:Middle Aged; D011379:Prognosis; D017430:Prostate-Specific Antigen / Q000097:blood*; D011468:Prostatectomy; D011471:Prostatic Neoplasms / Q000175:diagnosis* / Q000401:mortality / Q000601:surgery; D015996:Survival Rate
chemical_list: D017430:Prostate-Specific Antigen