UROLOGICAL SURVEY
PATHOLOGY
Active surveillance program for prostate cancer: an update of the Johns Hopkins experience
Tosoian JJ; Trock BJ; Landis P; Feng Z; Epstein JI; Partin AW; Walsh PC; Carter HB
The Johns Hopkins University School of Medicine, The James Buchanan Brady Urological Institute, and Johns Hopkins Hospital, Baltimore, MD
J Clin Oncol. 2011; 4. [Epub ahead of print]
PURPOSE: We assessed outcomes of men with prostate cancer enrolled in active surveillance.
PATIENTS AND METHODS: Since 1995, a total of 769 men diagnosed with prostate cancer have been followed prospectively (median follow-up, 2.7 years; range, 0.01 to 15.0 years) on active surveillance. Enrollment criteria were for very-low-risk cancers, defined by clinical stage (T1c), prostate-specific antigen density < 0.15 ng/mL, and prostate biopsy findings (Gleason score < 6, two or fewer cores with cancer, and = 50% cancer involvement of any core). Curative intervention was recommended on disease reclassification on the basis of biopsy criteria. The primary outcome was survival free of intervention, and secondary outcomes were rates of disease reclassification and exit from the program. Outcomes were compared between men who did and did not meet very-low-risk criteria.
RESULTS: The median survival free of intervention was 6.5 years (range, 0.0 to 15.0 years) after diagnosis, and the proportions of men remaining free of intervention after 2, 5, and 10 years of follow-up were 81%, 59%, and 41%, respectively. Overall, 255 men (33.2%) underwent intervention at a median of 2.2 years (range, 0.6 to 10.2 years) after diagnosis; 188 men (73.7%) underwent intervention on the basis of disease reclassification on biopsy. The proportions of men who underwent curative intervention (P = 0.026) or had biopsy reclassification (P < 0.001) were significantly lower in men who met enrollment criteria than in those who did not. There were no prostate cancer deaths.
CONCLUSION: For carefully selected men, active surveillance with curative intent appears to be a safe alternative to immediate intervention. Limiting surveillance to very-low-risk patients may reduce the frequency of adverse outcomes.
Editorial Comment
The authors studied the outcomes of men with prostate cancer enrolled in active surveillance comparing patients who did and did not meet very-low-risk criteria. Very-low-risk was defined according to the contemporary analysis of Bastian et al. for Epstein's criteria for insignificant cancer on needle biopsy: clinical stage T1c, prostate-specific antigen density < 0.15 ng/mL, Gleason score = 6, two or fewer cores with cancer, and = 50% cancer involvement of any core.
During the follow-up period the proportions of men who underwent curative intervention (p = 0.026) or had biopsy reclassification (more than 2 cores, Gleason score > 6, or > 50% cancer involvement of any core) (p < 0.001) were significantly lower in men who met very-low-risk criteria. There were also no prostate cancer deaths in this cohort of patients.
The authors conclude that for carefully selected men, active surveillance limited to patients with very-low-risk cancers according to Epstein's criteria for insignificant cancer may significantly reduce the frequency of adverse outcomes.
Dr. Athanase Billis
Full-Professor of Pathology
State University of Campinas, Unicamp
Campinas, São Paulo, Brazil
E-mail: athanase@fcm.unicamp.br
- 1. Bastian PJ, Mangold LA, Epstein JI, Partin AW: Characteristics of insignificant clinical T1c prostate tumors. A contemporary analysis. Cancer. 2004; 101: 2001-5.
Publication Dates
-
Publication in this collection
30 May 2011 -
Date of issue
Apr 2011
