A single centre experience of active surveillance as management strategy for low-risk prostate cancer in Ireland.
BACKGROUND
Active surveillance (AS) is a management strategy for addressing the widely acknowledged problem of over diagnosis and over treatment of clinically indolent prostate cancer.


METHODS
A total of 80 patients were enrolled on the AS program in our institution between January 2008 and June 2012. All data were collected prospectively in a secure database.


RESULTS
The mean age of patients enrolled was 62.7 years (range 50-72). Median PSA at enrolment was 5.6 ng/mL (range 1.2-13.4). The mean follow-up was 32 months (range 2-54). In total, 85 % of patients had a repeat biopsy after 1-year with 30 % having another biopsy after 3 years. Overall, 45 % of patients remain on AS. In the remainder; 42.5 % of patients have been removed from AS for definitive treatment, while 8.75 % of patients are now on watchful waiting, 2.5 % of patients self discharged from the program and one patient died of cardiovascular disease. The prostate cancer specific survival rate is 100 %. Reasons for removal from AS and referral for treatment were; 67.6 % of patients had upgrade of disease on repeat biopsy, 17.6 % of patients had PSA progression, 11.8 % patients had progression of disease on MRI, and one patient developed a palpable nodule. Regarding definitive treatment; 52.9 % of patients have been for referred for external beam radiotherapy, 14.7 % have been referred for brachytherapy, 29.4 % have been referred for surgery and one patient has refused definitive treatment.


CONCLUSIONS
Our findings to date support active surveillance as a valid strategy for early, localised prostate cancer.
Department of Urology, Beaumont Hospital, Dublin, Ireland, jamesforde@rcsi.ie.
J C
JC
Forde
P J
PJ
Daly
S
S
White
M
M
Morrin
G P
GP
Smyth
B D P
BD
O'Neill
R E
RE
Power
D000328:Adult; D000368:Aged; D019468:Disease Management; D006801:Humans; D007494:Ireland / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D011159:Population Surveillance; D017430:Prostate-Specific Antigen / Q000097:blood; D011471:Prostatic Neoplasms / Q000097:blood / Q000175:diagnosis* / Q000453:epidemiology; D018570:Risk Assessment; D057832:Watchful Waiting / Q000706:statistics & numerical data*
D017430:Prostate-Specific Antigen