title: Surveillance biopsy and active treatment during active surveillance for low-risk prostate cancer.
abstract: BACKGROUND
  The goals of the study were to examine surveillance biopsy and active treatment in patients under active surveillance (AS) for low-risk prostate cancer and to determine the active treatment-free survival rate.
  
  
  METHODS
  The subjects were 87 patients with low-risk prostate cancer who were under AS between 2000 and 2010. The eligibility criteria for AS were T1c, Gleason score ≤ 6, prostate-specific antigen level ≤ 10 ng/ml, one or two positive biopsies, maximum cancer involvement ≤ 50 %, and age ≤ 80 years old.
  
  
  RESULTS
  Of the 87 patients, 48 underwent the first surveillance biopsy (55.2 %). In this biopsy, no cancer was found in 33.3 % of cases, 27.1 % remained eligible for AS, and 39.6 % did not meet the AS criteria (up-grade 22.9 %, up-volume 16.7 %). A second surveillance-biopsy was performed at 1.9 years after the first biopsy. No cancer was found in 20.0 % of cases, 40.0 % remained eligible for AS, and 40.0 % did not meet the AS criteria (up-grade 26.7 %, up-volume 13.3 %). A total of 50 patients received treatment by 1.7 years after starting AS, mainly due to an up-grade or up-volume. However, some patients underwent radiotherapy despite biopsy results indicating no cancer or eligibility for AS. The active treatment-free survival rate was 64.1 % after 2 years.
  
  
  CONCLUSIONS
  Surveillance biopsy is important for identifying patients who require active treatment. The results in this study allowed determination of the active treatment-free survival rate and are informative for making treatment decisions.
authors.affiliation: Department of Urology, National Hospital Organization Shikoku Cancer Center, 160 Minamiumemoto, Matsuyama, 791-0280, Japan, khashine@shikoku-cc.go.jp.
authors.forename: Katsuyoshi
authors.initials: K
authors.lastname: Hashine
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Iio
authors.forename: Yoshiteru
authors.initials: Y
authors.lastname: Ueno
authors.forename: Shohei
authors.initials: S
authors.lastname: Tsukimori
authors.forename: Iku
authors.initials: I
authors.lastname: Ninomiya
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001706:Biopsy; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D017430:Prostate-Specific Antigen / Q000032:analysis / Q000378:metabolism; D011471:Prostatic Neoplasms / Q000378:metabolism / Q000401:mortality / Q000473:pathology* / Q000628:therapy*; D012307:Risk Factors
chemical_list: D017430:Prostate-Specific Antigen