title: Outcomes of men with screen-detected prostate cancer eligible for active surveillance who were managed expectantly.
abstract: BACKGROUND
  The incidence of small, localised, well-differentiated prostate cancer (PCa) is increasing, mainly as a result of screening. Many of these cancers will not progress, and radical therapy may lead to substantial overtreatment. Active surveillance (AS) has emerged as an alternative.
  
  
  OBJECTIVE
  To retrospectively validate the currently used criteria for eligibility for AS.
  
  
  METHODS
  For this cohort study, data from 616 men who were diagnosed with PCa between 1994 and 2007 at a mean age of 66.3 yr in four centres of the European Randomized Study of Screening for Prostate Cancer (ERSPC) were combined. All patients fit the criteria for AS (prostate-specific antigen [PSA] < or = 10.0 ng/ml, PSA-density < 0.2 ng/ml per ml, stage T1C/T2, Gleason score < or = 3 + 3 = 6, and < or = 2 positive biopsy cores), and initially they were managed expectantly. Median follow-up was 3.91 yr.
  
  
  METHODS
  Disease specific-, overall-, and treatment-free survival were studied. Present PSA characteristics were assessed and also compared between men who were switching to deferred active therapy during follow-up and men remaining untreated.
  
  
  CONCLUSIONS
  The calculated (Kaplan-Meier) 10-yr PCa-specific survival (21 patients at risk) was 100%, which sharply contrasted with 77% overall survival. Men still alive showed favourable PSA characteristics. Although the calculated 10-yr treatment-free survival was only 43%, objective signs of progression often did not indicate the shift to radical treatment. The cohort consisted of men on AS and those on watchful waiting (WW); information on comorbidity or psychological distress was not available.
  
  
  CONCLUSIONS
  AS seems justified in selected men with screen-detected PCa. Prospective protocol-based AS programs are necessary to optimise selection criteria and to find the appropriate trigger points for switching to active therapy. Possible negative psychological reactions with AS against improved quality of life by withholding side-effects from radical treatment should be considered.
authors.affiliation: Department of Urology, Erasmus University Medical Centre, Rotterdam, The Netherlands. r.vandenbergh@erasmusmc.nl
authors.forename: Roderick C N
authors.initials: RC
authors.lastname: van den Bergh
authors.forename: Stijn
authors.initials: S
authors.lastname: Roemeling
authors.forename: Monique J
authors.initials: MJ
authors.lastname: Roobol
authors.forename: Gunnar
authors.initials: G
authors.lastname: Aus
authors.forename: Jonas
authors.initials: J
authors.lastname: Hugosson
authors.forename: Antti S
authors.initials: AS
authors.lastname: Rannikko
authors.forename: Teuvo L
authors.initials: TL
authors.lastname: Tammela
authors.forename: Chris H
authors.initials: CH
authors.lastname: Bangma
authors.forename: Fritz H
authors.initials: FH
authors.lastname: Schröder
mesh_terms: D000368:Aged; D006801:Humans; D008297:Male; D008875:Middle Aged; D011159:Population Surveillance; D011471:Prostatic Neoplasms / Q000175:diagnosis* / Q000628:therapy; D012189:Retrospective Studies