PURPOSE: We report oncologic outcomes for men with Grade Group 1 prostate cancer managed with active surveillance at a tertiary cancer center. MATERIALS AND METHODS: A total of 2,907 patients were managed with active surveillance between 2000 and 2017, of whom 2,664 had Grade Group 1 disease. Patients were recommended confirmatory biopsy to verify eligibility and were followed semiannually with prostate specific antigen, digital rectal examination and review of symptoms. Magnetic resonance imaging was increasingly used in recent years. Biopsy was repeated every 2 to 3 years or after a sustained prostate specific antigen increase or changes in magnetic resonance imaging/digital rectal examination. The Kaplan-Meier method was used to estimate probabilities of treatment, progression and development of metastasis. RESULTS: Median patient age at diagnosis was 62 years. For men with Grade Group 1 prostate cancer the treatment-free probability at 5, 10 and 15 years was 76% (95% CI 74-78), 64% (95% CI 61-68) and 58% (95% CI 51-64), respectively. At 5, 10 and 15 years there were 1,146, 220 and 25 men at risk for metastasis, respectively. Median followup for those without metastasis was 4.3 years (95% CI 2.3-6.9). Distant metastasis developed in 5 men. Upon case note review only 2 of these men were deemed to have disease that could have been cured on immediate treatment. The risk of distant metastasis was 0.6% (95% CI 0.2-2.0) at 10 years. CONCLUSIONS: Active surveillance is a safe strategy over longer followup for appropriately selected patients with Grade Group 1 disease following a well-defined monitoring plan.
PURPOSE: We report oncologic outcomes for men with Grade Group 1 prostate cancer managed with active surveillance at a tertiary cancer center. MATERIALS AND METHODS: A total of 2,907 patients were managed with active surveillance between 2000 and 2017, of whom 2,664 had Grade Group 1 disease. Patients were recommended confirmatory biopsy to verify eligibility and were followed semiannually with prostate specific antigen, digital rectal examination and review of symptoms. Magnetic resonance imaging was increasingly used in recent years. Biopsy was repeated every 2 to 3 years or after a sustained prostate specific antigen increase or changes in magnetic resonance imaging/digital rectal examination. The Kaplan-Meier method was used to estimate probabilities of treatment, progression and development of metastasis. RESULTS: Median patient age at diagnosis was 62 years. For men with Grade Group 1 prostate cancer the treatment-free probability at 5, 10 and 15 years was 76% (95% CI 74-78), 64% (95% CI 61-68) and 58% (95% CI 51-64), respectively. At 5, 10 and 15 years there were 1,146, 220 and 25 men at risk for metastasis, respectively. Median followup for those without metastasis was 4.3 years (95% CI 2.3-6.9). Distant metastasis developed in 5 men. Upon case note review only 2 of these men were deemed to have disease that could have been cured on immediate treatment. The risk of distant metastasis was 0.6% (95% CI 0.2-2.0) at 10 years. CONCLUSIONS: Active surveillance is a safe strategy over longer followup for appropriately selected patients with Grade Group 1 disease following a well-defined monitoring plan.
Authors: Ryan K Berglund; Timothy A Masterson; Kinjal C Vora; Scott E Eggener; James A Eastham; Bertrand D Guillonneau Journal: J Urol Date: 2008-09-17 Impact factor: 7.450
Authors: Johann P Ingimarsson; Maria O Celaya; Michael Laviolette; Judy R Rees; Elias S Hyams Journal: Cancer Causes Control Date: 2015-04-04 Impact factor: 2.506
Authors: Ari Adamy; David S Yee; Kazuhito Matsushita; Alexandra Maschino; Angel Cronin; Andrew Vickers; Bertrand Guillonneau; Peter T Scardino; James A Eastham Journal: J Urol Date: 2010-12-17 Impact factor: 7.450
Authors: Freddie C Hamdy; Jenny L Donovan; J Athene Lane; Malcolm Mason; Chris Metcalfe; Peter Holding; Michael Davis; Tim J Peters; Emma L Turner; Richard M Martin; Jon Oxley; Mary Robinson; John Staffurth; Eleanor Walsh; Prasad Bollina; James Catto; Andrew Doble; Alan Doherty; David Gillatt; Roger Kockelbergh; Howard Kynaston; Alan Paul; Philip Powell; Stephen Prescott; Derek J Rosario; Edward Rowe; David E Neal Journal: N Engl J Med Date: 2016-09-14 Impact factor: 91.245
Authors: Anna Bill-Axelson; Lars Holmberg; Hans Garmo; Jennifer R Rider; Kimmo Taari; Christer Busch; Stig Nordling; Michael Häggman; Swen-Olof Andersson; Anders Spångberg; Ove Andrén; Juni Palmgren; Gunnar Steineck; Hans-Olov Adami; Jan-Erik Johansson Journal: N Engl J Med Date: 2014-03-06 Impact factor: 91.245
Authors: Martin G Sanda; Jeffrey A Cadeddu; Erin Kirkby; Ronald C Chen; Tony Crispino; Joann Fontanarosa; Stephen J Freedland; Kirsten Greene; Laurence H Klotz; Danil V Makarov; Joel B Nelson; George Rodrigues; Howard M Sandler; Mary Ellen Taplin; Jonathan R Treadwell Journal: J Urol Date: 2017-12-15 Impact factor: 7.450
Authors: Luke P O'Connor; Alex Z Wang; Nitin K Yerram; Amir H Lebastchi; Michael Ahdoot; Sandeep Gurram; Johnathan Zeng; Sherif Mehralivand; Stephanie Harmon; Maria J Merino; Howard L Parnes; Peter L Choyke; Baris Turkbey; Bradford J Wood; Peter A Pinto Journal: Urology Date: 2020-07-15 Impact factor: 2.649
Authors: Matthew B Clements; Xin Lin; Caroline Gmelich; Emily A Vertosick; Andrew J Vickers; Michael K Manasia; Natalie C Wolchasty; Peter T Scardino; James A Eastham; Vincent P Laudone; Karim A Touijer; Behfar Ehdaie Journal: Urol Pract Date: 2021-09-01
Authors: Ghalib Jibara; Daniel D Sjoberg; Gillian L Stearns; Yariv Stabholz; Ali Fathollahi; Laura S Leddy; Nicole Benfante; Behfar Ehdaie; Jonathan A Coleman; James A Eastham; Jaspreet S Sandhu Journal: Urology Date: 2021-02-02 Impact factor: 2.633
Authors: Andreas G Wibmer; Joshua Chaim; Yulia Lakhman; Robert A Lefkowitz; Josip Nincevic; Ines Nikolovski; Evis Sala; Mithat Gonen; Sigrid V Carlsson; Samson W Fine; Michael J Zelefsky; Peter Scardino; Hedvig Hricak; Hebert Alberto Vargas Journal: J Urol Date: 2020-11-18 Impact factor: 7.450
Authors: Alex Z Wang; Luke P O’Conno; Nitin K Yerram; Lori Long; Johnathan Zeng; Sherif Mehralivand; Stephanie A Harmon; Amir H Lebastchi; Michael Ahdoot; Patrick T Gomella; Sandeep Gurram; Peter L Choyke; Maria J Merino; Joanna H Shih; Bradford J Wood; Baris Turkbey; Peter A Pinto Journal: J Urol Date: 2020-07-27 Impact factor: 7.450