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J Clin Oncol. 2015 Oct 20;33(30):3379-85. doi: 10.1200/JCO.2015.62.5764. Epub 2015 Aug 31.

Intermediate and Longer-Term Outcomes From a Prospective Active-Surveillance Program for Favorable-Risk Prostate Cancer.

Author information

  • 1All authors: The Johns Hopkins University School of Medicine, The James Buchanan Brady Urological Institute, Johns Hopkins Hospital, Baltimore, MD.
  • 2All authors: The Johns Hopkins University School of Medicine, The James Buchanan Brady Urological Institute, Johns Hopkins Hospital, Baltimore, MD. hcarter@jhmi.edu.

Abstract

PURPOSE:

To assess long-term outcomes of men with favorable-risk prostate cancer in a prospective, active-surveillance program.

METHODS:

Curative intervention was recommended for disease reclassification to higher cancer grade or volume on prostate biopsy. Primary outcomes were overall, cancer-specific, and metastasis-free survival. Secondary outcomes were the cumulative incidence of reclassification and curative intervention. Factors associated with grade reclassification and curative intervention were evaluated in a Cox proportional hazards model.

RESULTS:

A total of 1,298 men (median age, 66 years) with a median follow-up of 5 years (range, 0.01 to 18.00 years) contributed 6,766 person-years of follow-up since 1995. Overall, cancer-specific, and metastasis-free survival rates were 93%, 99.9%, and 99.4%, respectively, at 10 years and 69%, 99.9%, and 99.4%, respectively, at 15 years. The cumulative incidence of grade reclassification was 26% at 10 years and was 31% at 15 years; cumulative incidence of curative intervention was 50% at 10 years and was 57% at 15 years. The median treatment-free survival was 8.5 years (range, 0.01 to 18 years). Factors associated with grade reclassification were older age (hazard ratio [HR], 1.03 for each additional year; 95% CI, 1.01 to 1.06), prostate-specific antigen density (HR, 1.21 per 0.1 unit increase; 95% CI, 1.12 to 1.46), and greater number of positive biopsy cores (HR, 1.47 for each additional positive core; 95% CI, 1.26 to 1.69). Factors associated with intervention were prostate-specific antigen density (HR, 1.38 per 0.1 unit increase; 95% CI, 1.22 to 1.56) and a greater number of positive biopsy cores (HR, 1.35 for one additional positive core; 95% CI, 1.19 to 1.53).

CONCLUSION:

Men with favorable-risk prostate cancer should be informed of the low likelihood of harm from their diagnosis and should be encouraged to consider surveillance rather than curative intervention.

PMID:
26324359
PMCID:
PMC4863946
DOI:
10.1200/JCO.2015.62.5764
[PubMed - indexed for MEDLINE]
Free PMC Article
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