Acceptance and durability of surveillance as a management choice in men with screen-detected, low-risk prostate cancer: improved outcomes with stringent enrollment criteria.
OBJECTIVE
To analyze the acceptance rate and durability of surveillance among contemporary men with low-risk prostate cancer managed at a large, US academic institution.


METHODS
Patients with low-risk parameters on initial and repeat biopsy were offered surveillance regardless of age. Regular clinical evaluation and repeat prostate biopsy were recommended every 1-2 years, and intervention was recommended based on adverse clinical and pathologic parameters on follow-up. Acceptance rate of active surveillance, freedom from intervention, and freedom from recommended intervention were measured.


CONCLUSIONS
Of 202 low-risk patients, 86 (43%) chose immediate treatment and 116 (57%) underwent repeat biopsy for consideration of surveillance. Intervention was recommended after initial repeat biopsy in 27 (23%) men because of higher-risk features, leaving a total of 89 men on surveillance. Over a median follow-up of 33 months, 16 men were ultimately treated and 8 were recommended to undergo treatment because of adverse clinical features on subsequent evaluations. Of the men on surveillance, the 3-year freedom from intervention and freedom from recommended intervention was 87% (95% CI, 78-93) and 93% (95% CI, 85-97), respectively.


CONCLUSIONS
Acceptance of surveillance (57%) in low-risk patients in this series is substantially higher than previous reports, and approximately one-third of these patients are ultimately managed by surveillance using stringent criteria. The risk of reclassification to a more aggressive cancer over short-term follow-up in appropriately selected patients is low.
Glickman Urololgical and Kidney Institute, Cleveland Clinic, Cleveland, OH 44195, USA.
Ranko
R
Miocinovic
J Stephen
JS
Jones
Akshat C
AC
Pujara
Eric A
EA
Klein
Andrew J
AJ
Stephenson
D000368:Aged; D001707:Biopsy, Needle / Q000706:statistics & numerical data; D006801:Humans; D008207:Lymphatic Metastasis; D008297:Male; D008403:Mass Screening; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D018579:Patient Selection; D011159:Population Surveillance; D011471:Prostatic Neoplasms / Q000175:diagnosis / Q000473:pathology / Q000628:therapy*; D012189:Retrospective Studies; D018570:Risk Assessment; D057832:Watchful Waiting / Q000458:organization & administration