title: Outcome following active surveillance of men with screen-detected prostate cancer. Results from the Göteborg randomised population-based prostate cancer screening trial.
abstract: BACKGROUND
  Active surveillance (AS) has emerged as a treatment strategy for reducing overtreatment of screen-detected, low-risk prostate cancer (PCa).
  
  
  OBJECTIVE
  To assess outcomes following AS of men with screen-detected PCa.
  
  
  METHODS
  Of the 968 men who were diagnosed with screen-detected PCa between 1995 and 2010 in the Göteborg randomised, population-based PCa screening trial, 439 were managed with AS and were included in this study. Median age at diagnosis was 65.4 yr of age, and median follow-up was 6.0 yr from diagnosis.
  
  
  METHODS
  The study participants were followed at intervals of 3-12 mo and were recommended to switch to deferred active treatment in case of a progression in prostate-specific antigen, grade, or stage.
  
  
  METHODS
  The end points-overall survival (OS), treatment-free survival, failure-free (no relapse after radical treatment) survival, and cancer-specific survival-were calculated for various risk groups (very low, low, intermediate, and high) with Kaplan-Meier estimates. A Cox proportional hazards model as well as a competing risk analysis were used to assess whether risk group or age at diagnosis was associated with failure after AS.
  
  
  CONCLUSIONS
  Forty-five per cent of all screen-detected PCa were managed with AS, and very low-risk and low-risk PCa constituted 60% of all screen-detected PCa. Thirty-seven per cent (162 of 439) switched from surveillance to deferred active treatment, and 39 men failed AS. The 10-yr OS, treatment-free survival, and failure-free survival were 81.1%, 45.4%, and 86.4%, respectively (Kaplan-Meier estimates). Men with low-, intermediate-, and high-risk tumours had a hazard ratio for failure of 2.1 (p=0.09), 3.6 (p=0.002), and 4.6 (p=0.15), respectively, compared to very low-risk tumours (Cox regression). Only one PCa death occurred, and one patient developed metastasis (both in the intermediate-risk group). The main limitation of this study is the relatively short follow-up.
  
  
  CONCLUSIONS
  A large proportion of men with screen-detected PCa can be managed with AS. AS appears safe for men with low-risk PCa.
authors.affiliation: Department of Urology, Institute of Clinical Sciences, Sahlgrenska Academy at the University of Göteborg, Sweden. r.godtman@gmail.com
authors.forename: Rebecka Arnsrud
authors.initials: RA
authors.lastname: Godtman
authors.forename: Erik
authors.initials: E
authors.lastname: Holmberg
authors.forename: Ali
authors.initials: A
authors.lastname: Khatami
authors.forename: Johan
authors.initials: J
authors.lastname: Stranne
authors.forename: Jonas
authors.initials: J
authors.lastname: Hugosson
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001706:Biopsy; D018450:Disease Progression; D018572:Disease-Free Survival; D006801:Humans; D007610:Kallikreins / Q000097:blood*; D053208:Kaplan-Meier Estimate; D008297:Male; D008403:Mass Screening / Q000379:methods; D008875:Middle Aged; D060787:Neoplasm Grading; D009364:Neoplasm Recurrence, Local; D009367:Neoplasm Staging; D011159:Population Surveillance; D011237:Predictive Value of Tests; D016016:Proportional Hazards Models; D017430:Prostate-Specific Antigen / Q000097:blood*; D011471:Prostatic Neoplasms / Q000097:blood / Q000175:diagnosis* / Q000453:epidemiology / Q000628:therapy; D018570:Risk Assessment; D012307:Risk Factors; D013548:Sweden / Q000453:epidemiology; D013997:Time Factors; D015854:Up-Regulation; D057832:Watchful Waiting
chemical_list: C549870:KLK3 protein, human; D007610:Kallikreins; D017430:Prostate-Specific Antigen