title: Prostate cancer mortality following active surveillance versus immediate radical prostatectomy.
abstract: OBJECTIVE
  [corrected] Active surveillance has been endorsed for low-risk prostate cancer, but information about long-term outcomes and comparative effectiveness of active surveillance is lacking. The purpose of this study is to project prostate cancer mortality under active surveillance followed by radical prostatectomy versus under immediate radical prostatectomy.
  
  
  METHODS
  A simulation model was developed to combine information on time from diagnosis to treatment under active surveillance and associated disease progression from a Johns Hopkins active surveillance cohort (n = 769), time from radical prostatectomy to recurrence from cases in the CaPSURE database with T-stage ≤ T2a (n = 3,470), and time from recurrence to prostate cancer death from a T-stage ≤ T2a Johns Hopkins cohort of patients whose disease recurred after radical prostatectomy (n = 963). Results were projected for a hypothetical cohort aged 40 to 90 years with low-risk prostate cancer (T-stage ≤ T2a, Gleason score ≤ 6, and prostate-specific antigen level ≤ 10 ng/mL).
  
  
  RESULTS
  The model projected that 2.8% of men on active surveillance and 1.6% of men with immediate radical prostatectomy would die of their disease in 20 years. Corresponding lifetime estimates were 3.4% for active surveillance and 2.0% for immediate radical prostatectomy. The average projected increase in life expectancy associated with immediate radical prostatectomy was 1.8 months. On average, the model projected that men on active surveillance would remain free of treatment for an additional 6.4 years relative to men treated immediately.
  
  
  CONCLUSIONS
  Active surveillance is likely to produce a very modest decline in prostate cancer-specific survival among men diagnosed with low-risk prostate cancer but could lead to significant benefits in terms of quality of life.
authors.affiliation: Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, WA, USA.
authors.forename: Jing
authors.initials: J
authors.lastname: Xia
authors.forename: Bruce J
authors.initials: BJ
authors.lastname: Trock
authors.forename: Matthew R
authors.initials: MR
authors.lastname: Cooperberg
authors.forename: Roman
authors.initials: R
authors.lastname: Gulati
authors.forename: Steven B
authors.initials: SB
authors.lastname: Zeliadt
authors.forename: John L
authors.initials: JL
authors.lastname: Gore
authors.forename: Daniel W
authors.initials: DW
authors.lastname: Lin
authors.forename: Peter R
authors.initials: PR
authors.lastname: Carroll
authors.forename: H Ballentine
authors.initials: HB
authors.lastname: Carter
authors.forename: Ruth
authors.initials: R
authors.lastname: Etzioni
mesh_terms: D000328:Adult; D000368:Aged; D018450:Disease Progression; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D060787:Neoplasm Grading; D009367:Neoplasm Staging; D017430:Prostate-Specific Antigen / Q000097:blood*; D011468:Prostatectomy / Q000379:methods*; D011471:Prostatic Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery; D011788:Quality of Life; D018570:Risk Assessment
chemical_list: D017430:Prostate-Specific Antigen