Document Detail

Active surveillance: the Canadian experience with an "inclusive approach".
MedLine Citation:
PMID:  23271779     Owner:  NLM     Status:  MEDLINE    
Active surveillance has evolved to become a standard of care for favorable-risk prostate cancer. This is a summary of the rationale, method, and results of active surveillance beginning in 1995 with the first prospective trial of this approach. This was a prospective, single-arm cohort study. Patients were managed with an initial expectant approach. Definitive intervention was offered to those patients with a prostate-specific antigen (PSA) doubling time of less than 3 years, Gleason score progression (to 4+3 or greater), or unequivocal clinical progression. Survival analysis and Cox proportional hazard model were applied to the data. Since November 1995, 450 patients have been managed with active surveillance. The cohort included men under 70 with favorable-risk disease and men of age more than 70 with favorable- or intermediate-risk cancer (Gleason score 3+4 or PSA 10-15). Median follow-up is 6.8 years (range 1-16 years). Overall survival is 78.6%. Ten-year prostate cancer actuarial survival is 97.2%. Five of 450 patients (1.1%) have died of prostate cancer. Thirty percent of patients have been reclassified as higher-risk patients and offered definitive therapy. The commonest indication for treatment was a PSA doubling time less than 3 years (48%) or Gleason upgrading (26%). Of 117 patients treated radically, the PSA failure rate was 50%. This represents 13% of the total cohort. Most PSA failures occurred early; at 2 years, 44% of the treated patients had PSA failure. The hazard ratio for non-prostate cancer mortality to prostate cancer mortality was 18.6 at 10 years. In conclusion, we observed a very low rate of prostate cancer mortality in an intermediate time frame. Among the one-third of patients who were reclassified as higher risk and retreated, PSA failure was relatively common. However, other-cause mortality accounted for almost all of the deaths. Further studies are warranted to improve the identification of patients who harbor more aggressive disease in spite of favorable clinical parameters at diagnosis [reproduced from Klotz (1) with permission from Wolters Kluwer Health].
Laurence Klotz
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Publication Detail:
Type:  Clinical Trial; Journal Article    
Journal Detail:
Title:  Journal of the National Cancer Institute. Monographs     Volume:  2012     ISSN:  1745-6614     ISO Abbreviation:  J. Natl. Cancer Inst. Monographs     Publication Date:  2012 Dec 
Date Detail:
Created Date:  2012-12-28     Completed Date:  2013-06-21     Revised Date:  2013-09-03    
Medline Journal Info:
Nlm Unique ID:  9011255     Medline TA:  J Natl Cancer Inst Monogr     Country:  United States    
Other Details:
Languages:  eng     Pagination:  234-41     Citation Subset:  IM    
Sunnybrook Health Sciences Centre, Division of Urology, University of Toronto, 2075 Bayview Ave, Toronto, Ontario.
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MeSH Terms
Cohort Studies
Disease Progression
Neoplasm Grading
Prospective Studies
Prostate-Specific Antigen / blood
Prostatic Neoplasms / diagnosis,  mortality*,  therapy*
Survival Analysis
Watchful Waiting*
Reg. No./Substance:
EC Antigen

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