Intermediate-Term Outcomes for Men with Very Low/Low and Intermediate/High Risk Prostate Cancer Managed by Active Surveillance

Abstract

No AccessJournal of UrologyAdult Urology1 Sep 2017Intermediate-Term Outcomes for Men with Very Low/Low and Intermediate/High Risk Prostate Cancer Managed by Active Surveillance Yaw A. Nyame, Nima Almassi, Samuel C. Haywood, Daniel J. Greene, Vishnu Ganesan, Charles Dai, Joseph Zabell, Chad Reichard, Hans Arora, Anna Zampini, Alice Crane, Daniel Hettel, Ahmed Elshafei, Khaled Fareed, Robert J. Stein, Ryan K. Berglund, Michael Gong, J. Stephen Jones, Eric A. Klein, and Andrew J. Stephenson Yaw A. NyameYaw A. Nyame , Nima AlmassiNima Almassi , Samuel C. HaywoodSamuel C. Haywood , Daniel J. GreeneDaniel J. Greene , Vishnu GanesanVishnu Ganesan , Charles DaiCharles Dai , Joseph ZabellJoseph Zabell , Chad ReichardChad Reichard , Hans AroraHans Arora , Anna ZampiniAnna Zampini , Alice CraneAlice Crane , Daniel HettelDaniel Hettel , Ahmed ElshafeiAhmed Elshafei , Khaled FareedKhaled Fareed , Robert J. SteinRobert J. Stein , Ryan K. BerglundRyan K. Berglund , Michael GongMichael Gong , J. Stephen JonesJ. Stephen Jones , Eric A. KleinEric A. Klein , and Andrew J. StephensonAndrew J. Stephenson View All Author Informationhttps://doi.org/10.1016/j.juro.2017.03.123AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract Purpose: We compare intermediate term clinical outcomes among men with favorable risk and intermediate/high risk prostate cancer managed by active surveillance. Materials and Methods: A total of 635 men with localized prostate cancer have been on active surveillance since 2002 at a high volume academic hospital in the United States. Median followup is 50.5 months (IQR 31.1–80.3). Time to event analysis was performed for our clinical end points. Results: Of the cohort 117 men (18.4%) had intermediate/high risk disease. Overall 5 and 10-year all cause survival was 98% and 94%, respectively. Cumulative metastasis-free survival at 5 and 10 years was 99% and 98%, respectively. To date no cancer specific deaths had been observed. Overall freedom from intervention was 61% and 49% at 5 and 10 years, respectively. Overall cumulative freedom from failure of active surveillance, defined as metastasis or biochemical failure after local therapy with curative intent, was 97% and 91% at 5 and 10 years, respectively. Of the men 21 (9.9%) experienced biochemical failure after deferred treatment and the 5-year progression-free probability was 92%. Compared to men with favorable risk disease those with intermediate/high risk cancer experienced no difference in metastases, surveillance failure or curative intervention. However, patients at higher risk were at significantly increased risk for all cause mortality, likely reflecting patient selection factors. These conclusions may be limited by the small number of events and the duration of our study. 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Volume 198Issue 3September 2017Page: 591-599 Advertisement Copyright & Permissions© 2017 by American Urological Association Education and Research, Inc.Keywordsrisk factorsprostatic neoplasmssentinel surveillancemortalityepidemiologyMetricsAuthor Information Yaw A. Nyame More articles by this author Nima Almassi More articles by this author Samuel C. Haywood More articles by this author Daniel J. Greene More articles by this author Vishnu Ganesan More articles by this author Charles Dai More articles by this author Joseph Zabell More articles by this author Chad Reichard More articles by this author Hans Arora More articles by this author Anna Zampini More articles by this author Alice Crane More articles by this author Daniel Hettel More articles by this author Ahmed Elshafei Financial interest and/or other relationship with Endocare. More articles by this author Khaled Fareed More articles by this author Robert J. Stein More articles by this author Ryan K. Berglund More articles by this author Michael Gong More articles by this author J. Stephen Jones Financial interest and/or other relationship with Healthtronics and Cook. More articles by this author Eric A. Klein More articles by this author Andrew J. Stephenson More articles by this author Expand All Advertisement PDF downloadLoading ...