title: Acknowledging unreported problems with active surveillance for prostate cancer: a prospective single-centre observational study.
abstract: OBJECTIVE
  To report outcomes of patients with localised prostate cancer (PCa) managed with active surveillance (AS) in a standard clinical setting.
  
  
  METHODS
  Single-centre, prospective, observational study.
  
  
  METHODS
  Non-academic, average-size hospital in Switzerland.
  
  
  METHODS
  Prospective, observational study at a non-academic, average-size hospital in Switzerland. Inclusion and progression criteria meet general recommendations. 157 patients at a median age of 67 (61-70) years were included from December 1999 to March 2012. Follow-up (FU) ended June 2013.
  
  
  RESULTS
  Median FU was 48 (30-84) months. Overall confirmed reclassification rate was 20% (32/157). 20 men underwent radical prostatectomy with 1 recurrence, 11 had radiation therapy with 2 prostate-specific antigen relapses, and 1 required primary hormone ablation with a fatal outcome. Kaplan-Meier estimates for those remaining in the study showed an overall survival of 92%, cancer-specific survival of 99% and reclassification rate of 41%. Dropout rate was 36% and occurred at a median of 48 (21-81) months after inclusion. 68 (43%) men are still under AS.
  
  
  CONCLUSIONS
  Careful administration of AS can and will yield excellent results in long-term management of PCa, and also helps physicians and patients alike to balance quality of life and mortality. Our data revealed significant dropout from FU. Patient non-compliance can be a relevant problem in AS.
authors.affiliation: Division of Urology, Department of Surgery, Kantonsspital Baden, Baden, Switzerland.
authors.forename: Lukas J
authors.initials: LJ
authors.lastname: Hefermehl
authors.affiliation: Division of Urology, Department of Surgery, Kantonsspital Baden, Baden, Switzerland.
authors.forename: Daniel
authors.initials: D
authors.lastname: Disteldorf
authors.affiliation: Division of Urology, Department of Surgery, Kantonsspital Baden, Baden, Switzerland.
authors.forename: Kurt
authors.initials: K
authors.lastname: Lehmann
mesh_terms: D000368:Aged; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000453:epidemiology; D010352:Patient Dropouts / Q000706:statistics & numerical data; D011446:Prospective Studies; D011468:Prostatectomy; D011471:Prostatic Neoplasms / Q000453:epidemiology / Q000628:therapy*; D013557:Switzerland
keywords: active surveillance; clinical setting; compliance; dropout; localized; prostate cancer