Outcomes of Active Surveillance for Clinically Localized Prostate Cancer in the Prospective, Multi-Institutional Canary PASS Cohort.
OBJECTIVE
Active surveillance represents a strategy to address the overtreatment of prostate cancer, yet uncertainty regarding individual patient outcomes remains a concern. We evaluated outcomes in a prospective multicenter study of active surveillance.


METHODS
We studied 905 men in the prospective Canary PASS enrolled between 2008 and 2013. We collected clinical data at study entry and at prespecified intervals, and determined associations with adverse reclassification, defined as increased Gleason grade or greater cancer volume on followup biopsy. We also evaluated the relationships of clinical parameters with pathology findings in participants who underwent surgery after a period of active surveillance.


RESULTS
At a median followup of 28 months 24% of participants experienced adverse reclassification, of whom 53% underwent treatment while 31% continued on active surveillance. Overall 19% of participants received treatment, 68% with adverse reclassification, while 32% opted for treatment without disease reclassification. In multivariate Cox proportional hazards modeling the percent of biopsy cores with cancer, body mass index and prostate specific antigen density were associated with adverse reclassification (p=0.01, 0.04, 0.04, respectively). Of 103 participants subsequently treated with radical prostatectomy 34% had adverse pathology, defined as primary pattern 4-5 or nonorgan confined disease, including 2 with positive lymph nodes, with no significant relationship between risk category at diagnosis and findings at surgery (p=0.76).


CONCLUSIONS
Most men remain on active surveillance at 5 years without adverse reclassification or adverse pathology at surgery. However, clinical factors had only a modest association with disease reclassification, supporting the need for approaches that improve the prediction of this outcome.
Fred Hutchinson Cancer Research Center, Seattle, Washington; University of Washington, Seattle, Washington.
Lisa F
LF
Newcomb
University of Texas Health Sciences Center at San Antonio, San Antonio, Texas.
Ian M
IM
Thompson
Fred Hutchinson Cancer Research Center, Seattle, Washington.
Hilary D
HD
Boyer
Stanford University, Stanford, California.
James D
JD
Brooks
University of California San Francisco, San Francisco, California.
Peter R
PR
Carroll
University of California San Francisco, San Francisco, California.
Matthew R
MR
Cooperberg
Veterans Affairs Puget Sound Health Care System, Seattle, Washington.
Atreya
A
Dash
University of Washington, Seattle, Washington.
William J
WJ
Ellis
University of British Columbia, Vancouver, British Columbia, Canada.
Ladan
L
Fazli
Fred Hutchinson Cancer Research Center, Seattle, Washington.
Ziding
Z
Feng
University of British Columbia, Vancouver, British Columbia, Canada.
Martin E
ME
Gleave
University of Michigan, Ann Arbor, Michigan.
Priya
P
Kunju
Eastern Virginia Medical School, Norfolk, Virginia.
Raymond S
RS
Lance
Cleveland Clinic, Cleveland, Ohio.
Jesse K
JK
McKenney
University of California San Francisco, San Francisco, California.
Maxwell V
MV
Meng
University of Texas Health Sciences Center at San Antonio, San Antonio, Texas.
Marlo M
MM
Nicolas
Beth Israel Deaconess Medical Center, Boston, Massachusetts.
Martin G
MG
Sanda
University of California San Francisco, San Francisco, California.
Jeffry
J
Simko
University of British Columbia, Vancouver, British Columbia, Canada.
Alan
A
So
University of Washington, Seattle, Washington.
Maria S
MS
Tretiakova
Eastern Virginia Medical School, Norfolk, Virginia.
Dean A
DA
Troyer
University of Washington, Seattle, Washington.
Lawrence D
LD
True
University of Washington, Seattle, Washington.
Funda
F
Vakar-Lopez
Veterans Affairs Puget Sound Health Care System, Seattle, Washington.
Jeff
J
Virgin
Beth Israel Deaconess Medical Center, Boston, Massachusetts.
Andrew A
AA
Wagner
University of Michigan, Ann Arbor, Michigan.
John T
JT
Wei
Fred Hutchinson Cancer Research Center, Seattle, Washington.
Yingye
Y
Zheng
Fred Hutchinson Cancer Research Center, Seattle, Washington.
Peter S
PS
Nelson
Fred Hutchinson Cancer Research Center, Seattle, Washington; University of Washington, Seattle, Washington; Veterans Affairs Puget Sound Health Care System, Seattle, Washington. Electronic address: dlin@uw.edu.
Daniel W
DW
Lin
D000368:Aged; D014408:Biomarkers, Tumor / Q000032:analysis; D001706:Biopsy; D006801:Humans; D008297:Male; D008875:Middle Aged; D060787:Neoplasm Grading; D011159:Population Surveillance; D011446:Prospective Studies; D011468:Prostatectomy; D011471:Prostatic Neoplasms / Q000473:pathology* / Q000601:surgery; D012307:Risk Factors; D016896:Treatment Outcome; D047368:Tumor Burden; D057832:Watchful Waiting
D014408:Biomarkers, Tumor
prospective studies; prostatic neoplasms; watchful waiting