title: Active surveillance can reduce overtreatment in patients with low-risk prostate cancer.
abstract: BACKGROUND
  The incidence of prostate cancer in Denmark rose approximately 50% from 2000 to 2009 in parallel with the introduction of prostate-specific antigen (PSA)-testing. Available evidence indicates a significant overtreatment of patients with low-risk prostate cancer. Active surveillance has been proposed as an observation strategy to reduce overtreatment and limit curatively intended therapy to those patients who need it. We reported the first Danish results from an active surveillance cohort.
  
  
  METHODS
  A total of 167 patients were prospectively followed in an active surveillance programme.
  
  
  RESULTS
  The median follow-up was 3.4 years (1.1-9.5). At entry the median age was 65 years (51-73), 94% had a Gleason score ≤ 6, 87.4% had a PSA ≤ 10 ng/ml and 99% ≤ cT2a. Ten patients progressed on digital rectal examination, 40 patients progressed due to a short PSA doubling time, and 34 patients progressed on re-biopsy. A total of 59 patients discontinued active surveillance. The estimated five-year probability of remaining on active surveillance was 60.0% (95% confidence interval 50.9-69.1%).
  
  
  CONCLUSIONS
  Active surveillance as a management strategy for patients with clinically localized, low-risk prostate cancer is accepted by patients, seems feasible and can reduce overtreatment. However, long-term follow-up data are lacking and considerable uncertainties about optimal selection and progression criteria remain.
  
  
  BACKGROUND
  The authors received financial support from the IMK Almene Fond.
  
  
  BACKGROUND
  not relevant.
authors: Department of Urology and the Urology Research Unit, Section 7521, Rigshospitalet, 2100 Copenhagen, Denmark. thomsen.frederik@gmail.com
authors: Frederik Birkebaek
authors: FB
authors: Thomsen
authors: Martin Andreas
authors: MA
authors: Røder
authors: Helle
authors: H
authors: Hvarness
authors: Peter
authors: P
authors: Iversen
authors: Klaus
authors: K
authors: Brasso
mesh_terms: D000368:Aged; D001706:Biopsy; D051517:Digital Rectal Examination; D018450:Disease Progression; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D017430:Prostate-Specific Antigen / Q000097:blood; D011471:Prostatic Neoplasms / Q000097:blood / Q000473:pathology* / Q000628:therapy*; D018570:Risk Assessment; D013997:Time Factors; D019564:Unnecessary Procedures; D057832:Watchful Waiting
chemical_list: D017430:Prostate-Specific Antigen