title: Active surveillance for low-risk prostate cancer: Need for intervention and survival at 10 years.
abstract: BACKGROUND
  To describe the need for treatment and cancer-specific and overall survival in a contemporary active surveillance (AS) cohort.
  
  
  METHODS
  Historical cohort study of men diagnosed with localized prostate cancer between 1997 and 2009 and managed with AS at a tertiary care center. Inclusion criteria were Gleason score ≤ 6 (Gleason score of 7 in select patients),≤ 3/12 cores positive, and prostate-specific antigen (PSA) level< 20 ng/ml. Survival analyses were conducted using the Kaplan-Meier method.
  
  
  RESULTS
  A total of 469 men with median age at diagnosis of 68.1 years (interquartile range [IQR]: 62.5-73.4) were followed up for a median of 4.8 years (IQR: 3.4-7.3). Median PSA level at diagnosis was 5.1 ng/ml (IQR: 4.0-6.9), with 94% of them having PSA level<10 ng/ml. Overall, 98.3% (461/469) of patients had a Gleason score of 6 and 1.7% (8/469) had a Gleason score of 3+4 = 7, and 94.0% (441/469) had T1c stage disease. Freedom from treatment was 77% at 5 years and 62% at 10 years. A total of 116 (24.7%) patients received treatment during the course of surveillance. Reasons for treatment included 44.8% (52/116) for pathologic reclassification, 30.2% (35/116) for PSA progression, 12.1% (14/116) for patient preference, 5.2% (6/116) for digital rectal examination progression, and 4.3% (5/116) for metastatic disease. Of the patients treated, 59 (50.1%) received radiation, 26 (22.4%) underwent surgery, 17 (14.7%) received brachytherapy, and 14 (12.1%) received androgen-deprivation therapy. Cancer-specific survival was 100% at 5 and 10 years. Overall survival was 95% at 5 years and 88% at 10 years.
  
  
  CONCLUSIONS
  In a contemporary cohort of men with low-risk prostate cancer, AS allowed avoidance of treatment most of them. Common reasons for change in management were Gleason upgrading and volume progression on prostate rebiopsy.
authors.affiliation: Division of Urology, Department of Surgery, Brigham and Women's Hospital, Boston, MA.
authors.forename: Mark A
authors.initials: MA
authors.lastname: Preston
authors.affiliation: Department of Urology, Massachusetts General Hospital, Boston, MA. Electronic address: afeldman@partners.org.
authors.forename: Adam S
authors.initials: AS
authors.lastname: Feldman
authors.affiliation: Department of Radiation Oncology, Massachusetts General Hospital, Boston, MA.
authors.forename: John J
authors.initials: JJ
authors.lastname: Coen
authors.affiliation: Department of Urology, Massachusetts General Hospital, Boston, MA.
authors.forename: W Scott
authors.initials: WS
authors.lastname: McDougal
authors.affiliation: Division of Medical Oncology, Massachusetts General Hospital, Boston, MA.
authors.forename: Matthew R
authors.initials: MR
authors.lastname: Smith
authors.affiliation: Department of Radiation Oncology, Massachusetts General Hospital, Boston, MA.
authors.forename: Jonathan J
authors.initials: JJ
authors.lastname: Paly
authors.affiliation: Department of Urology, Boston Medical Center, Boston, MA.
authors.forename: Robert
authors.initials: R
authors.lastname: Carrasquillo
authors.affiliation: Department of Urology, Massachusetts General Hospital, Boston, MA.
authors.forename: Chin-Lee
authors.initials: CL
authors.lastname: Wu
authors.affiliation: Department of Urology, Massachusetts General Hospital, Boston, MA.
authors.forename: Douglas M
authors.initials: DM
authors.lastname: Dahl
authors.affiliation: Department of Urology, Massachusetts General Hospital, Boston, MA.
authors.forename: Glen W
authors.initials: GW
authors.lastname: Barrisford
authors.affiliation: Department of Urology, Massachusetts General Hospital, Boston, MA.
authors.forename: Michael L
authors.initials: ML
authors.lastname: Blute
authors.affiliation: Department of Radiation Oncology, Massachusetts General Hospital, Boston, MA.
authors.forename: Anthony I
authors.initials: AI
authors.lastname: Zietman
mesh_terms: D000368:Aged; D015331:Cohort Studies; D018450:Disease Progression; D018572:Disease-Free Survival; D005500:Follow-Up Studies; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D011471:Prostatic Neoplasms / Q000401:mortality* / Q000473:pathology*; D057832:Watchful Waiting / Q000706:statistics & numerical data*
keywords: Active surveillance; Intervention; Prostate cancer; Survival