Two Decades of Active Surveillance for Prostate Cancer in a Single-Center Cohort: Favorable Outcomes after Transurethral Resection of the Prostate

Abstract

Objective: To report the outcomes of active surveillance (AS) for low-risk prostate cancer (PCa) in a single-center cohort. Patients and Methods: This is a prospective, single-center, observational study. The cohort included all patients who underwent AS for PCa between December 1999 and December 2020 at our institution. Follow-up appointments (FU) ended in February 2021. Results: A total of 413 men were enrolled in the study, and 391 had at least one FU. Of those who followed up, 267 had PCa diagnosed by transrectal ultrasound (TRUS)-guided biopsy (T1c: 68.3%), while 124 were diagnosed after transurethral resection of the prostate (TURP) (T1a/b: 31.7%). Median FU was 46 months (IQR 25–90). Cancer specific survival was 99.7% and overall survival was 92.3%. Median reclassification time was 11.2 years. After 20 years, 25% of patients were reclassified within 4.58 years, 6.6% opted to switch to watchful waiting, 4.1% died, 17.4% were lost to FU, and 46.8% remained on AS. Those diagnosed by TRUS had a significantly higher reclassification rate than those diagnosed by TURP (p < 0.0001). Men diagnosed by targeted MRI/TRUS fusion biopsy tended to have a higher reclassification probability than those diagnosed by conventional template biopsies (p = 0.083). Conclusions: Our single-center cohort spanning over two decades revealed that AS remains a safe option for low-risk PCa even in the long term. Approximately half of AS enrollees will eventually require definitive treatment due to disease progression. Men with incidental prostate cancer were significantly less likely to have disease progression.

Toxicity and outcomes after external beam irradiation for prostate cancer in patients with prior holmium laser enucleation of the prostate: Early experience

“… 21 In comparison to men who underwent TURP, men diagnosed by TRUS guided biopsy had significantly higher reclassification, defined as pathological progression of tumor, (25% at 3.6 years vs. 25% at 11.2 years) while on active surveillance ( p < .001). 21 …”

“…21 In comparison to men who underwent TURP, men diagnosed by TRUS guided biopsy had significantly higher reclassification, defined as pathological progression of tumor, (25% at 3.6 years vs. 25% at 11.2 years) while on active surveillance (p < .001). 21 In patients who undergo a surgical procedure for BPH, incidental prostate cancer may be found in up to 12% of patients. 22,23 Many of these patients have low-risk disease and can be managed with active surveillance or watchful waiting.…”

Ultra-Hypofractionated Stereotactic Body Radiotherapy for Localized Prostate Cancer: Clinical Outcomes, Patterns of Recurrence, Feasibility of Definitive Salvage Treatment, and Competing Oncological Risk

“…AS should be considered as the treatment of choice for the majority of PCa patients with localized disease, as it does not compromise survival while significantly improving quality of life [ 1 , 3 ]. However, interventional methods of treatment are not exclusive but complementary, as approximately half of the patients will eventually receive active treatment [ 1 , 25 ], and some will decline AS to start off with. In general, there are three ultra-short radiotherapy modalities that can be considered in such setting, including low-dose-rate brachytherapy (LDR-BT), high-dose-rate brachytherapy (HDR-BT), and UHRT.…”

Ex Vivo Fluorescence Confocal Microscopy (FCM) of Prostate Biopsies Rethought: Opportunities of Intraoperative Examinations of MRI-Guided Targeted Biopsies in Routine Diagnostics

“…Interventional therapies such as radical prostatectomy (RPE) or radiation are recommended for localized tumors in the intermediate-and high-risk groups [4]. Recent long-term outcomes showed that active surveillance (AS) is a safe option for localized low-risk tumors, aiming to reduce Diagnostics 2022, 12, 1146. https://doi.org/10.3390/diagnostics12051146 https://www.mdpi.com/journal/diagnostics overtreatment and negative side effects of interventional treatments [5]. These patients follow up on a routine schedule with regular PSA measurements, digital rectal examinations and prostate biopsies to determine whether further AS is warranted or a progression of the tumor disease requiring interventional therapy is present.…”