title: Active surveillance program for prostate cancer: an update of the Johns Hopkins experience.
abstract: OBJECTIVE
  We assessed outcomes of men with prostate cancer enrolled in active surveillance.
  
  
  METHODS
  Since 1995, a total of 769 men diagnosed with prostate cancer have been followed prospectively (median follow-up, 2.7 years; range, 0.01 to 15.0 years) on active surveillance. Enrollment criteria were for very-low-risk cancers, defined by clinical stage (T1c), prostate-specific antigen density < 0.15 ng/mL, and prostate biopsy findings (Gleason score ≤ 6, two or fewer cores with cancer, and ≤ 50% cancer involvement of any core). Curative intervention was recommended on disease reclassification on the basis of biopsy criteria. The primary outcome was survival free of intervention, and secondary outcomes were rates of disease reclassification and exit from the program. Outcomes were compared between men who did and did not meet very-low-risk criteria.
  
  
  RESULTS
  The median survival free of intervention was 6.5 years (range, 0.0 to 15.0 years) after diagnosis, and the proportions of men remaining free of intervention after 2, 5, and 10 years of follow-up were 81%, 59%, and 41%, respectively. Overall, 255 men (33.2%) underwent intervention at a median of 2.2 years (range, 0.6 to 10.2 years) after diagnosis; 188 men (73.7%) underwent intervention on the basis of disease reclassification on biopsy. The proportions of men who underwent curative intervention (P = .026) or had biopsy reclassification (P < .001) were significantly lower in men who met enrollment criteria than in those who did not. There were no prostate cancer deaths.
  
  
  CONCLUSIONS
  For carefully selected men, active surveillance with curative intent appears to be a safe alternative to immediate intervention. Limiting surveillance to very-low-risk patients may reduce the frequency of adverse outcomes.
authors.affiliation: The Johns Hopkins University School of Medicine, The James Buchanan Brady Urological Institute, and Johns Hopkins Hospital, Baltimore, MD 21287-2101, USA.
authors.forename: Jeffrey J
authors.initials: JJ
authors.lastname: Tosoian
authors.forename: Bruce J
authors.initials: BJ
authors.lastname: Trock
authors.forename: Patricia
authors.initials: P
authors.lastname: Landis
authors.forename: Zhaoyong
authors.initials: Z
authors.lastname: Feng
authors.forename: Jonathan I
authors.initials: JI
authors.lastname: Epstein
authors.forename: Alan W
authors.initials: AW
authors.lastname: Partin
authors.forename: Patrick C
authors.initials: PC
authors.lastname: Walsh
authors.forename: H Ballentine
authors.initials: HB
authors.lastname: Carter
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001706:Biopsy; D005500:Follow-Up Studies; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D017430:Prostate-Specific Antigen / Q000097:blood; D011471:Prostatic Neoplasms / Q000097:blood / Q000401:mortality / Q000473:pathology*; D057832:Watchful Waiting / Q000379:methods*
chemical_list: D017430:Prostate-Specific Antigen