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. Design: Single-centre, prospective, observational study. Setting: Non-academic, average-size hospital in Switzerland. Participants: 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 prostatespecific 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.