Active surveillance for prostate cancer: An Australian experience

Abstract

OBJECTIVE: • To assess the patient and cancer characteristics as well as outcomes of a large cohort of Australian men who chose active surveillance (AS) as initial management of their low-risk prostate cancer. PATIENTS AND METHODS: • Men treated by one surgeon who had chosen AS as the primary management for prostate cancer were identifi ed from the records. • The patient and cancer data recorded included: patient age, prostate-specifi c antigen (PSA) concentration at diagnosis, mode of prostate cancer detection. • For prostate cancer diagnosed at prostate biopsy, data were collected for the number of cores taken as well as positive core number, cancer burden, and Gleason grade. • Survival analysis was used to determine the duration of AS. RESULTS: • In all, 154 men with low-risk prostate cancer with a median (range) age 63.0 (36-81) years and a mean (range) PSA concentration of 6.5 (0.3-22) ng/mL underwent AS. • The median (range) duration of AS was 1.9 (0.1-16.6) years. AS was ceased in 29 patients (19%) after a mean (range) of 2.4 (0.2-7.9) years. Of these, 26 were upstaged, one chose curative treatment despite stable disease, and two died from disease not related to prostate cancer. • Actuarial analysis on the probability of still being on AS after 5 years was 61.9% (95% confi dence interval [ CI ] 46.2-74.2%) and after 10 years was 45.0% (95% CI 21.3-66.2%). • While the period of follow-up is short, there were no biochemical recurrences in men who underwent curative treatment and no deaths from prostate cancer. CONCLUSION: • AS is an acceptable mode of initial treatment in Australian men with low-risk prostate cancer. © 2012 The Authors © 2012 BJU International.