A single centre experience of active surveillance as management strategy for low-risk prostate cancer in Ireland

• Published in: Irish journal of medical science 2014-09, Vol.183 (3), p.377-382
• Main Authors: Forde, J. C., Daly, P. J., White, S., Morrin, M., Smyth, G. P., O’Neill, B. D. P., Power, R. E.
• Format: Article
• Language: English
• Subjects: Adult; Aged; Disease Management; Family Medicine; General Practice; Humans; Internal Medicine; Ireland - epidemiology; Male; Medicine; Medicine & Public Health; Middle Aged; Original Article; Population Surveillance; Prostate-Specific Antigen - blood; Prostatic Neoplasms - blood; Prostatic Neoplasms - diagnosis; Prostatic Neoplasms - epidemiology; Risk Assessment; Watchful Waiting - statistics & numerical data
• ISSN: 0021-1265; 1863-4362
• DOI: 10.1007/s11845-013-1024-9

Introduction Active surveillance (AS) is a management strategy for addressing the widely acknowledged problem of over diagnosis and over treatment of clinically indolent prostate cancer. Methods A total of 80 patients were enrolled on the AS program in our institution between January 2008 and June 2012. All data were collected prospectively in a secure database. Results The mean age of patients enrolled was 62.7 years (range 50–72). Median PSA at enrolment was 5.6 ng/mL (range 1.2–13.4). The mean follow-up was 32 months (range 2–54). In total, 85 % of patients had a repeat biopsy after 1-year with 30 % having another biopsy after 3 years. Overall, 45 % of patients remain on AS. In the remainder; 42.5 % of patients have been removed from AS for definitive treatment, while 8.75 % of patients are now on watchful waiting, 2.5 % of patients self discharged from the program and one patient died of cardiovascular disease. The prostate cancer specific survival rate is 100 %. Reasons for removal from AS and referral for treatment were; 67.6 % of patients had upgrade of disease on repeat biopsy, 17.6 % of patients had PSA progression, 11.8 % patients had progression of disease on MRI, and one patient developed a palpable nodule. Regarding definitive treatment; 52.9 % of patients have been for referred for external beam radiotherapy, 14.7 % have been referred for brachytherapy, 29.4 % have been referred for surgery and one patient has refused definitive treatment. Conclusion Our findings to date support active surveillance as a valid strategy for early, localised prostate cancer.