INTRODUCTION: The incidence of prostate cancer in Denmark rose approximately 50% from 2000 to 2009 in parallel with the introduction of prostate-specific antigen (PSA)-testing. Available evidence indicates a significant overtreatment of patients with low-risk prostate cancer. Active surveillance has been proposed as an observation strategy to reduce overtreatment and limit curatively intended therapy to those patients who need it. We reported the first Danish results from an active surveillance cohort. MATERIAL AND METHODS: A total of 167 patients were prospectively followed in an active surveillance programme. RESULTS: The median follow-up was 3.4 years (1.1-9.5). At entry the median age was 65 years (51-73), 94% had a Gleason score ≤ 6, 87.4% had a PSA ≤ 10 ng/ml and 99% ≤ cT2a. Ten patients progressed on digital rectal examination, 40 patients progressed due to a short PSA doubling time, and 34 patients progressed on re-biopsy. A total of 59 patients discontinued active surveillance. The estimated five-year probability of remaining on active surveillance was 60.0% (95% confidence interval 50.9-69.1%). CONCLUSION: Active surveillance as a management strategy for patients with clinically localized, low-risk prostate cancer is accepted by patients, seems feasible and can reduce overtreatment. However, long-term follow-up data are lacking and considerable uncertainties about optimal selection and progression criteria remain. FUNDING: The authors received financial support from the IMK Almene Fond. TRIAL REGISTRATION: not relevant.
INTRODUCTION: The incidence of prostate cancer in Denmark rose approximately 50% from 2000 to 2009 in parallel with the introduction of prostate-specific antigen (PSA)-testing. Available evidence indicates a significant overtreatment of patients with low-risk prostate cancer. Active surveillance has been proposed as an observation strategy to reduce overtreatment and limit curatively intended therapy to those patients who need it. We reported the first Danish results from an active surveillance cohort. MATERIAL AND METHODS: A total of 167 patients were prospectively followed in an active surveillance programme. RESULTS: The median follow-up was 3.4 years (1.1-9.5). At entry the median age was 65 years (51-73), 94% had a Gleason score ≤ 6, 87.4% had a PSA ≤ 10 ng/ml and 99% ≤ cT2a. Ten patients progressed on digital rectal examination, 40 patients progressed due to a short PSA doubling time, and 34 patients progressed on re-biopsy. A total of 59 patients discontinued active surveillance. The estimated five-year probability of remaining on active surveillance was 60.0% (95% confidence interval 50.9-69.1%). CONCLUSION: Active surveillance as a management strategy for patients with clinically localized, low-risk prostate cancer is accepted by patients, seems feasible and can reduce overtreatment. However, long-term follow-up data are lacking and considerable uncertainties about optimal selection and progression criteria remain. FUNDING: The authors received financial support from the IMK Almene Fond. TRIAL REGISTRATION: not relevant.
Authors: Javier Romero-Otero; Borja García-Gómez; José M Duarte-Ojeda; Alfredo Rodríguez-Antolín; Antoni Vilaseca; Sigrid V Carlsson; Karim A Touijer Journal: Int J Urol Date: 2015-11-30 Impact factor: 3.369
Authors: Michele Fascelli; Arvin K George; Thomas Frye; Baris Turkbey; Peter L Choyke; Peter A Pinto Journal: Curr Urol Rep Date: 2015-06 Impact factor: 3.092
Authors: Isabel Heidegger; Viktor Skradski; Eberhard Steiner; Helmut Klocker; Renate Pichler; Andreas Pircher; Wolfgang Horninger; Jasmin Bektic Journal: PLoS One Date: 2015-02-06 Impact factor: 3.240