Acknowledging unreported problems with active surveillance for prostate cancer: a prospective single-centre observational study

Lukas J Hefermehl, Daniel Disteldorf, Kurt Lehmann, Lukas J Hefermehl, Daniel Disteldorf, Kurt Lehmann

Abstract

Objective: To report outcomes of patients with localised prostate cancer (PCa) managed with active surveillance (AS) in a standard clinical setting.

Design: Single-centre, prospective, observational study.

Setting: Non-academic, average-size hospital in Switzerland.

Participants: Prospective, observational study at a non-academic, average-size hospital in Switzerland. Inclusion and progression criteria meet general recommendations. 157 patients at a median age of 67 (61-70) years were included from December 1999 to March 2012. Follow-up (FU) ended June 2013.

Results: Median FU was 48 (30-84) months. Overall confirmed reclassification rate was 20% (32/157). 20 men underwent radical prostatectomy with 1 recurrence, 11 had radiation therapy with 2 prostate-specific antigen relapses, and 1 required primary hormone ablation with a fatal outcome. Kaplan-Meier estimates for those remaining in the study showed an overall survival of 92%, cancer-specific survival of 99% and reclassification rate of 41%. Dropout rate was 36% and occurred at a median of 48 (21-81) months after inclusion. 68 (43%) men are still under AS.

Conclusions: Careful administration of AS can and will yield excellent results in long-term management of PCa, and also helps physicians and patients alike to balance quality of life and mortality. Our data revealed significant dropout from FU. Patient non-compliance can be a relevant problem in AS.

Keywords: active surveillance; clinical setting; compliance; dropout; localized; prostate cancer.

Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

Figures

Figure 1
Figure 1
Flow chart of active surveillance cohort. ADT, androgen deprivation therapy; DRE, digital rectal examination; EBRT, external beam radiotherapy; FU, follow-up; GS, Gleason score; PCa, prostate cancer; PSA, prostate-specific antigen; RP, radical prostatectomy.
Figure 2
Figure 2
Reclassification events with regard to follow-up time and Gleason score (GS; *median time of dropout).
Figure 3
Figure 3
Kaplan-Meier analysis of death and intervention (combined; cancer-specific survival: 99%, overall survival: 92%, reclassification: 41%).
Figure 4
Figure 4
Recurrence-free survival after treatment was 90%.
Figure 5
Figure 5
Time points of dropout events.

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