Active Surveillance: An Update From A Large Contemporary Cohort

Abstract: 376
Date & Time: May 20, 2012 10:30 AM
Session Title: Prostate Cancer: Localized I
Sources of Funding: None

Introduction and Objectives
Active surveillance (AS) is increasingly accepted as a management strategy for carefully selected patients with low and intermediate risk prostate cancer. We describe disease, demographic and outcomes data of patients who are currently enrolled within the University of California San Francisco (UCSF) AS protocol.

We retrospectively reviewed clinical data from men who received no active treatment for at least 6 months after enrolling in AS. Clinical risk at diagnosis is defined using the UCSF Cancer of the Prostate Risk Assessment (CAPRA) score for which low (0-2), intermediate (3-5), and high (6-10) groups have been validated. Biopsy progression is defined as upgrade to at least Gleason 7 or increase in volume >33% cores. Patients may consent to participate in research at first follow up visit.

Of 775 men enrolled in AS in 1990-2011, 75% were diagnosed in 2003 or later. To date, 652 have consented to research. Median follow-up was 50 months (6-222). Ninety-two percent were Caucasian with a mean age of 62.3 ±7.96 years. Two-thirds had clinical T1 disease. Median prostate specific antigen (PSA) at diagnosis was 5.3 ng/ml (interquartile range, IQR 4.0-7.4). CAPRA groups at diagnosis were 82% low risk and 18% intermediate risk. Of 523 (80%) men who underwent ≥1 repeat biopsies, 178 (34%) histologically upgraded and 51 (10%) were found to have increased volume in >33% positive cores while 178 (34%) had a negative pathology result. Treatment-free survival at 5 years was 63%. Nineteen percent underwent radical prostatectomy (RP), 11% radiotherapy, and 4% androgen deprivation therapy. Active treatment was prompted by biopsy progression (59%), PSA doubling time within 36 months (3%), or patient choice based on other clinical characteristics or personal preference (38%). For 122 men who underwent RP, 4-year PSA recurrence-free survival was 83%. Five-year disease-specific survival was 100% and overall survival was 97%.

The cohort's rate of treatment intervention is similar to other reports in the literature and is precipitated, most often, by grade migration. At intermediate follow-up, such a treatment approach seems safe.

Glass, Allison S. (San Francisco, CA); Cowan, Janet E.; Shinohara, Katsuto; Cooperberg, Matthew R.; Meng, Maxwell V.; Greene, Kirsten L.; Perez, Nannette; Carroll, Peter R. 
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