title: Five-year nationwide follow-up study of active surveillance for prostate cancer.
abstract: BACKGROUND
  Active surveillance (AS) is an important yet underutilized strategy to reduce prostate cancer (PCa) overtreatment.
  
  
  OBJECTIVE
  To examine the 5-yr outcomes of AS in a population-based setting.
  
  
  METHODS
  From the National Prostate Cancer Register of Sweden, we identified 11 726 men ≤70 yr diagnosed with very low-risk to intermediate-risk PCa from 2003 to 2007 who completed 5 yr of follow-up. Of these men, 1729 (15%) chose AS for the primary management strategy.
  
  
  METHODS
  We calculated the probability of discontinuation of AS over time, and Cox proportional hazards models were used to determine factors associated with discontinuation. Reasons for discontinuation were assessed by data extraction from medical charts.
  
  
  CONCLUSIONS
  By 5 yr, 64% of the men remained on AS. Predictors of discontinuation were younger age, fewer comorbidities, more education, higher prostate-specific antigen (PSA), and clinical stage T2 disease; marital status did not predict discontinuation. In a subset with data on the reason for discontinuation (86%), 20% of men discontinued because of patient preference, 52% because of PSA progression, 24% because of biopsy progression, and 3% for other reasons.
  
  
  CONCLUSIONS
  In a population-based setting, the majority of men remained on AS at 5 yr. However, one-fifth of the men who discontinued AS did so for nonbiologic reasons. Thus, there is a need for support and counseling for men to continue AS in the absence of signs of progression to improve adherence to AS and decrease overtreatment.
  
  
  RESULTS
  Active surveillance (AS) is an important option to delay or avoid treatment for men with favorable prostate cancer features. This study shows that at 5 yr, 64% of men across an entire population remained on AS. We concluded that AS is a durable option and that counseling may be useful to promote adherence for men without progression.
authors.affiliation: Department of Urology, New York University and Manhattan Veterans Affairs Medical Center, New York, NY, USA. Electronic address: stacyloeb@gmail.com.
authors.forename: Stacy
authors.initials: S
authors.lastname: Loeb
authors.affiliation: Regional Cancer Centre, Uppsala University Hospital, Uppsala, Sweden.
authors.forename: Yasin
authors.initials: Y
authors.lastname: Folkvaljon
authors.affiliation: Department of Urology, New York University and Manhattan Veterans Affairs Medical Center, New York, NY, USA.
authors.forename: Danil V
authors.initials: DV
authors.lastname: Makarov
authors.affiliation: Department of Urology, Helsingborg Hospital, Lund University, Lund, Sweden.
authors.forename: Ola
authors.initials: O
authors.lastname: Bratt
authors.affiliation: Department of Surgical Sciences, Uppsala University, Uppsala, Sweden.
authors.forename: Anna
authors.initials: A
authors.lastname: Bill-Axelson
authors.affiliation: Department of Surgical and Perioperative Sciences, Urology and Andrology, Umeå University, Umeå, Sweden.
authors.forename: Pär
authors.initials: P
authors.lastname: Stattin
mesh_terms: D000368:Aged; D001706:Biopsy; D018450:Disease Progression; D006801:Humans; D007610:Kallikreins / Q000097:blood; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D060787:Neoplasm Grading; D009367:Neoplasm Staging; D011237:Predictive Value of Tests; D011336:Probability; D011379:Prognosis; D016016:Proportional Hazards Models; D017430:Prostate-Specific Antigen / Q000097:blood; D011471:Prostatic Neoplasms / Q000097:blood / Q000175:diagnosis* / Q000453:epidemiology / Q000473:pathology; D012042:Registries; D012307:Risk Factors; D013548:Sweden / Q000453:epidemiology; D013997:Time Factors; D057832:Watchful Waiting
chemical_list: C549870:KLK3 protein, human; D007610:Kallikreins; D017430:Prostate-Specific Antigen
keywords: Active surveillance; Adverse pathology; Predictors; Prostate cancer; Upgrading