title: Five-year follow-up of active surveillance for prostate cancer: A Canadian community-based urological experience.
abstract: BACKGROUND
  We assessed oncological outcomes of active surveillance (AS) using a community database and identified factors associated with disease reclassification on surveillance biopsy.
  
  
  METHODS
  A retrospective review was performed on 200 men on AS. Prostate-specific antigen (PSA) was measured every 3 to 6 months. Prostate biopsies were performed every 1 to 4 years, and at the individual physician's discretion. Disease reclassification was defined as clinical T1 to cT2 progression, or histologically as >2 cores positive, Gleason score >6, or >50% core involvement on surveillance biopsy. Multivariate Cox regression analysis evaluated factors associated with disease reclassification. Kaplan-Meier survival curves were plotted.
  
  
  RESULTS
  We assessed a heterogeneous cohort of 86 patients, with a median age 67.2 years, who received ≥1 surveillance biopsies. The median follow-up was 5.2 years. The median times to first and second surveillance biopsies were 730 and 763 days, respectively. Overall, 47% of patients were reclassified on surveillance biopsy after a median 2.1 years. Factors associated with disease reclassification were PSA density >0.20 (p < 0.0001, hazard ratio [HR] 4.55, 95% confidence interval [CI] 2.116-9.782) and ≥3 positive cores (p = 0.0152, HR 3.956, 95% CI 1.304-12.003) at diagnosis, and number of positive cores on surveillance biopsy. In total, 25 (29%) patients received delayed intervention, with a median time to intervention of 2.6 years. The median time on AS was 4.4 years, with an overall survival of 95% and prostate-specific survival of 100%.
  
  
  CONCLUSIONS
  Our community study supports AS to reduce over-treatment of prostate cancer. PSA density >0.20 and ≥3 cores positive are associated with disease reclassification on surveillance biopsy.
authors.affiliation: Department of Urology, Dalhousie University, Halifax, NS;
authors.forename: J
authors.initials: J
authors.lastname: Matthew Andrews
authors.affiliation: Department of Urology, Dalhousie University, Saint John, NB.
authors.forename: James E
authors.initials: JE
authors.lastname: Ashfield
authors.affiliation: Department of Urology, Dalhousie University, Saint John, NB.
authors.forename: Michael
authors.initials: M
authors.lastname: Morse
authors.affiliation: Department of Urology, Dalhousie University, Saint John, NB.
authors.forename: Thomas F
authors.initials: TF
authors.lastname: Whelan