A single-center long-term experience of active surveillance for prostate cancer: 15 years of follow-up

Abstract

Purpose To describe a single-center 15-year experience of active surveillance (AS) for prostate cancer (PCa). Materials and Methods We retrospectively reviewed patients who underwent AS between 2003 and 2018. One hundred fifty-three patients were selected according to the following criteria: (1) biopsy Gleason pattern ≤3+4 with (2) ≤two positive core(s) and (3) ≤50% core involvement, clinical-stage ≤T2a, and prostate-specific antigen (PSA) ≤20 ng/mL. Follow-up included PSA measurement every six months, prostate biopsies at one year and then every 2–3 years, and MRI every year. Intervention was triggered by (1) Gleason score (GS) upgrading, (2) >two positive cores, or (3) PSA doubling-time in <3 years. Results Mean (±standard deviation) follow-up was 36.4 (±31.9) months. Ninety-three (60.8%) and 20 (13.1%) patients received second and third biopsies, respectively. Seventy-two patients (47.1%) discontinued AS for various reasons (59, intervention; 13, follow-up loss). Reasons for intervention consisted of GS upgrading (42.4%), >two positive cores (8.5%), abnormal PSA kinetics (11.9%), and patient preference (37.3%). Notably, 12 (25.5%) patients had pathologic GS ≥4+3 (unfavorable disease) and 3 (6.4%) patients had pathologic stage ≥T3a at radical prostatectomy. Median time to treatment-free survival was 19.5 months. Of the 59 patients who switched to intervention, biochemical recurrence was reported in only one (0.7%) patient. Conclusions AS is an available option for low-risk PCa in carefully selected patients. Further larger prospective studies are needed to determine the optimal criteria for AS, especially in Korean PCa patients.

Temporal changes of PIRADS scoring by radiologists and correlation to radical prostatectomy pathological outcomes

“…In our study, low risk tumors confirmed at RP were correlated with increasing categorization as PIRADS 1–3 and intermediate–high-risk tumors as PIRADS 4-5 with increased experience over time, with improvements in PIRADS 5 for SVI and BNI detection. These results suggest that high PIRADS in experienced centers can more accurately predict poor pathologic features after RP and caution against MRI-dependent clinical decision making in low volume institutions, especially when considering candidates for active surveillance 34 , 35 . Further large-scale prospective trials are required to validate our results.…”

Clinical utility of transperineal template-guided mapping prostate biopsy in a selection of patients under active surveillance and confirmation of patients with negative biopsy for prostate cancer

“…A study by Song et al has shown a long-term follow-up data of AS patients for 15 years, in which 38% of patients underwent radical treatment 23 , while Ha et al reported 48.6% of AS patients that received radical treatment over a follow-up of four years 24 . Patients in both of the aforementioned studies underwent TRUS-bx and were subsequently treated by AS based on pathology obtained from the TRUSbx cores.…”

Polygenic risk score for tumor aggressiveness and early-onset prostate cancer in Asians

“…Also, routine clinical parameters such as prostate volume or MRI findings were not available for analysis, the inclusion of which could have enhanced model performance. Inquiry for role in treatment selection in specific subgroups such as patients eligible for active surveillance requires further research, especially in Asian populations where the criteria for enrollment is still unclear 25 due to different tumor characteristics.…”