Pd55-03 active surveillance for low-risk prostate cancer in men under 60 years of age

You have accessJournal of UrologyProstate Cancer: Localized: Active Surveillance III1 Apr 2017PD55-03 ACTIVE SURVEILLANCE FOR LOW-RISK PROSTATE CANCER IN MEN UNDER 60 YEARS OF AGE Keyan Salari, David Kuppermann, Mark Preston, Douglas Dahl, Jason Efstathiou, Michael Blute, Danny Vesprini, Andrew Loblaw, Anthony Zietman, Laurence Klotz, and Adam Feldman Keyan SalariKeyan Salari More articles by this author , David KuppermannDavid Kuppermann More articles by this author , Mark PrestonMark Preston More articles by this author , Douglas DahlDouglas Dahl More articles by this author , Jason EfstathiouJason Efstathiou More articles by this author , Michael BluteMichael Blute More articles by this author , Danny VespriniDanny Vesprini More articles by this author , Andrew LoblawAndrew Loblaw More articles by this author , Anthony ZietmanAnthony Zietman More articles by this author , Laurence KlotzLaurence Klotz More articles by this author , and Adam FeldmanAdam Feldman More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2017.02.2426AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Active surveillance (AS) is increasingly used in managing low-risk prostate cancer. Data on outcomes of AS in younger men are limited. We present characteristics and outcomes of two cohorts of men who began AS at under 60 years of age. METHODS We reviewed our institutional AS databases at the Massachusetts General Hospital (MGH) (n = 990) and Sunnybrook Health Sciences Centre (n =1162) of men diagnosed with low-risk prostate cancer between 1990-2016 to identify 432 men under age 60 (n = 181, MGH; n = 251, Sunnybrook). Clinical outcomes were analyzed, including repeat biopsy data, progression to treatment, and pathologic staging in those who had surgical treatment. Survival estimates were generated by Kaplan-Meier analysis. RESULTS At diagnosis, median age was 55 years (IQR 53-57) and median PSA was 4.6 ng/mL (IQR 3.1-5.9), with only 11 of 432 men with PSA ≥10 ng/mL. The vast majority of patients had Gleason ≤6 (97.7%) and clinical stage T1 (91.9%) disease. With a median follow-up of 5.1 years (range: 0.05-21.7; IQR: 3.1-8.4), 84.3% (364/432) had a repeat biopsy with 62.6% (228/364) showing prostate cancer, 24.5% (89/364) benign, 7.7% (28/364) with PIN, and 5.2% (10/364) with atypia. Kaplan-Meier actuarial freedom-from-treatment was 74.3% at 5 years and 55.4% at 10 years. Of all 432 patients, 131 (30.3%) progressed to treatment for the following reasons: pathologic progression (64.1%), PSA progression (18.3%), patient preference (11.5%), volume progression (3.1%) and other reasons (3.1%). Among the 131 treated patients, 62.6% underwent radical prostatectomy, 13.0% underwent high-intensity focal ultrasound therapy, 12.2% underwent external beam radiation and 10.7% had brachytherapy. On pathologic review after surgery, 88.2% (60/68) were pT2, and 11.8% (8/68) pT3. Five patients developed metastasis (2 with positive lymph nodes at time of radical prostatectomy, 3 with distant metastasis). Metastasis-free survival was 99.7% and 97.5% at 5 and 10 years, respectively. There were no prostate-cancer specific deaths. CONCLUSIONS Active surveillance is a reasonable option for carefully selected men under 60 with low-risk prostate cancer. However, patients must be surveyed closely and understand the significant risk of ultimately needing treatment. © 2017FiguresReferencesRelatedDetails Volume 197Issue 4SApril 2017Page: e1051-e1052 Advertisement Copyright & Permissions© 2017MetricsAuthor Information Keyan Salari More articles by this author David Kuppermann More articles by this author Mark Preston More articles by this author Douglas Dahl More articles by this author Jason Efstathiou More articles by this author Michael Blute More articles by this author Danny Vesprini More articles by this author Andrew Loblaw More articles by this author Anthony Zietman More articles by this author Laurence Klotz More articles by this author Adam Feldman More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...