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Long-Term outcomes of active surveillance for prostate cancer – the memorial sloan kettering cancer center experience

Publication: Journal of Urology, December 2020

Purpose:

To report oncologic outcomes for men with Grade Group 1 prostate cancer managed with active surveillance (AS) at a tertiary cancer center.

Materials and Methods:

2,907 patients were managed with AS between 2000–2017 of whom 2,664 were Grade Group 1. Patients were recommended confirmatory biopsy to verify eligibility and were followed semi-annually with prostate-specific antigen (PSA), digital rectal examination (DRE) and review of symptoms. Magnetic resonance imaging (MRI) was increasingly used in recent years. Biopsy was repeated every 2–3 years or after a sustained PSA increase or changes in MRI/DRE. The Kaplan-Meier method was used to estimate probabilities of treatment, progression, and development of metastasis.

Results:

The median age at diagnosis was 62 years. For men with Grade Group 1 prostate cancer, the treatment-free probability at 5, 10, and 15 years was 76% (95% CI 74%–78%), 64% (95% CI 61%–68%), and 58% (95% CI 51%–64%), respectively. At 5, 10, and 15 years, there were 1,146, 220, and 25 men at risk for metastasis, respectively. The median follow-up for those without metastasis was 4.3 years (95% CI 2.3–6.9). Five men developed distant metastasis. Upon case note review, only two of these men were deemed to have disease that could have been cured on immediate treatment. The risk of distant metastasis was 0.6% (95% CI 0.2%–2.0%) at 10 years.

Conclusions:

AS is a safe strategy over longer follow-up for appropriately selected patients with Grade Group 1 following a well-defined monitoring plan.