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• W2111288468 abstract "No AccessJournal of UrologyAdult Urology1 Mar 2015Extended Followup and Risk Factors for Disease Reclassification in a Large Active Surveillance Cohort for Localized Prostate Cancer Christopher J. Welty, Janet E. Cowan, Hao Nguyen, Katsuto Shinohara, Nannette Perez, Kirsten L. Greene, June M. Chan, Maxwell V. Meng, Jeffry P. Simko, Matthew R. Cooperberg, and Peter R. Carroll Christopher J. WeltyChristopher J. Welty More articles by this author , Janet E. CowanJanet E. Cowan More articles by this author , Hao NguyenHao Nguyen More articles by this author , Katsuto ShinoharaKatsuto Shinohara Financial interest and/or other relationship with Nihon Mediphysics. More articles by this author , Nannette PerezNannette Perez More articles by this author , Kirsten L. GreeneKirsten L. Greene More articles by this author , June M. ChanJune M. Chan More articles by this author , Maxwell V. MengMaxwell V. Meng Financial interest and/or other relationship with Myriad Genetics, Maximum Medical Solutions and Genomic Health. More articles by this author , Jeffry P. SimkoJeffry P. Simko More articles by this author , Matthew R. CooperbergMatthew R. Cooperberg Financial interest and/or other relationship with Myriad Genetics, Genomic Health, Genome Dx, Astellas and Dendreon. More articles by this author , and Peter R. CarrollPeter R. Carroll Financial interest and/or other relationship with Genomic Health International and Myriad Genetics. More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2014.09.094AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract Purpose: Active surveillance to manage prostate cancer provides an alternative to immediate treatment in men with low risk prostate cancer. We report updated outcomes from a long-standing active surveillance cohort and factors associated with reclassification. Materials and Methods: We retrospectively reviewed data on all men enrolled in the active surveillance cohort at our institution with at least 6 months of followup between 1990 and 2013. Surveillance consisted of quarterly prostate specific antigen testing, repeat imaging with transrectal ultrasound at provider discretion and periodic repeat prostate biopsies. Factors associated with repeat biopsy reclassification and local treatment were determined by multivariate Cox proportional hazards regression. We also analyzed the association of prostate specific antigen density and outcomes stratified by prostate size. Results: A total of 810 men who consented to participate in the research cohort were followed on active surveillance for a median of 60 months. Of these men 556 (69%) met strict criteria for active surveillance. Five-year overall survival was 98%, treatment-free survival was 60% and biopsy reclassification-free survival was 40%. There were no prostate cancer related deaths. On multivariate analysis prostate specific antigen density was positively associated with the risk of biopsy reclassification and treatment while the number of biopsies and time between biopsies were inversely associated with the 2 outcomes (each p <0.01). When stratified by prostate volume, prostate specific antigen density remained significantly associated with biopsy reclassification for all strata but prostate specific antigen density was only significantly associated with treatment in men with a smaller prostate. Conclusions: Significant prostate cancer related morbidity and mortality remained rare at intermediate followup. Prostate specific antigen density was independently associated with biopsy reclassification and treatment while on active surveillance. References 1 Cancer Facts & Figures 2014. 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Google Scholar © 2015 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetailsCited byCooley L, Emeka A, Meyers T, Cooper P, Lin D, Finelli A, Eastham J, Logothetis C, Marks L, Vesprini D, Goldenberg S, Higano C, Pavlovich C, Chan J, Morgan T, Klein E, Barocas D, Loeb S, Helfand B, Scholtens D, Witte J and Catalona W (2021) Factors Associated with Time to Conversion from Active Surveillance to Treatment for Prostate Cancer in a Multi-Institutional CohortJournal of Urology, VOL. 206, NO. 5, (1147-1156), Online publication date: 1-Nov-2021.Maggi M, Cowan J, Fasulo V, Washington S, Lonergan P, Sciarra A, Nguyen H and Carroll P (2020) The Long-Term Risks of Metastases in Men on Active Surveillance for Early Stage Prostate CancerJournal of Urology, VOL. 204, NO. 6, (1222-1228), Online publication date: 1-Dec-2020.Lonergan P, Washington S, Cowan J, Zhao S, Nguyen H, Shinohara K, Cooperberg M and Carroll P (2020) Risk Factors for Biopsy Reclassification over Time in Men on Active Surveillance for Early Stage Prostate CancerJournal of Urology, VOL. 204, NO. 6, (1216-1221), Online publication date: 1-Dec-2020.Carlsson S, Benfante N, Alvim R, Sjoberg D, Vickers A, Reuter V, Fine S, Vargas H, Wiseman M, Mamoor M, Ehdaie B, Laudone V, Scardino P, Eastham J and Touijer K (2020) Risk of Metastasis in Men with Grade Group 2 Prostate Cancer Managed with Active Surveillance at a Tertiary Cancer CenterJournal of Urology, VOL. 203, NO. 6, (1117-1121), Online publication date: 1-Jun-2020.Schenk J, Newcomb L, Zheng Y, Faino A, Zhu K, Nyame Y, Brooks J, Carroll P, Cooperberg M, Dash A, Filson C, Gleave M, Liss M, Martin F, Morgan T, Nelson P, Thompson I, Wagner A and Lin D (2019) African American Race is Not Associated with Risk of Reclassification during Active Surveillance: Results from the Canary Prostate Cancer Active Surveillance StudyJournal of Urology, VOL. 203, NO. 4, (727-733), Online publication date: 1-Apr-2020.Sharma V, Wymer K, Borah B, Barocas D, Thompson R, Karnes R and Boorjian S (2019) Cost-Effectiveness of Active Surveillance, Radical Prostatectomy and External Beam Radiotherapy for Localized Prostate Cancer: An Analysis of the ProtecT TrialJournal of Urology, VOL. 202, NO. 5, (964-972), Online publication date: 1-Nov-2019.Balakrishnan A, Cowan J, Cooperberg M, Shinohara K, Nguyen H and Carroll P (2019) Evaluating the Safety of Active Surveillance: Outcomes of Deferred Radical Prostatectomy after an Initial Period of SurveillanceJournal of Urology, VOL. 202, NO. 3, (506-510), Online publication date: 1-Sep-2019.Tosoian J and George A (2019) Editorial CommentJournal of Urology, VOL. 201, NO. 4, (727-727), Online publication date: 1-Apr-2019.Taneja S (2018) Re: Role of Surveillance Biopsy with no Cancer as a Prognostic Marker for Reclassification: Results from the Canary Prostate Active Surveillance StudyJournal of Urology, VOL. 200, NO. 1, (30-30), Online publication date: 1-Jul-2018.Hassan O, Han M, Zhou A, Paulk A, Sun Y, Al-Harbi A, Alrajjal A, Baptista dos Santos F and Epstein J (2017) Incidence of Extraprostatic Extension at Radical Prostatectomy with Pure Gleason Score 3 + 3 = 6 (Grade Group 1) Cancer: Implications for Whether Gleason Score 6 Prostate Cancer Should be Renamed Not Cancer and for Selection Criteria for Active SurveillanceJournal of Urology, VOL. 199, NO. 6, (1482-1487), Online publication date: 1-Jun-2018.Taneja S (2018) Re: Comparative Analysis of Biopsy Upgrading in Four Prostate Cancer Active Surveillance CohortsJournal of Urology, VOL. 199, NO. 5, (1112-1113), Online publication date: 1-May-2018.Taneja S (2017) Re: Adverse Pathologic Findings for Men Electing Immediate Radical Prostatectomy: Defining a Favorable Intermediate-Risk GroupJournal of Urology, VOL. 199, NO. 2, (343-343), Online publication date: 1-Feb-2018.Leapman M and Carroll P (2016) Risk Stratification of Newly Diagnosed Prostate Cancer with Genomic PlatformsUrology Practice, VOL. 4, NO. 4, (322-328), Online publication date: 1-Jul-2017.Taneja S (2016) Re: Quantified Clinical Risk Change as an End Point during Prostate Cancer Active SurveillanceJournal of Urology, VOL. 197, NO. 3 Part 1, (699-700), Online publication date: 1-Mar-2017.Luckenbaugh A, Auffenberg G, Hawken S, Dhir A, Linsell S, Kaul S and Miller D (2016) Variation in Guideline Concordant Active Surveillance Followup in Diverse Urology PracticesJournal of Urology, VOL. 197, NO. 3 Part 1, (621-626), Online publication date: 1-Mar-2017.Nassiri N, Margolis D, Natarajan S, Sharma D, Huang J, Dorey F and Marks L (2016) Targeted Biopsy to Detect Gleason Score Upgrading during Active Surveillance for Men with Low versus Intermediate Risk Prostate CancerJournal of Urology, VOL. 197, NO. 3 Part 1, (632-639), Online publication date: 1-Mar-2017.Cher M, Dhir A, Auffenberg G, Linsell S, Gao Y, Rosenberg B, Jafri S, Klotz L, Miller D, Ghani K, Bernstein S, Montie J and Lane B (2016) Appropriateness Criteria for Active Surveillance of Prostate CancerJournal of Urology, VOL. 197, NO. 1, (67-74), Online publication date: 1-Jan-2017.Kelly S, Van Den Eeden S, Hoffman R, Aaronson D, Lobo T, Luta G, Leimpter A, Shan J, Potosky A and Taylor K (2016) Sociodemographic and Clinical Predictors of Switching to Active Treatment among a Large, Ethnically Diverse Cohort of Men with Low Risk Prostate Cancer on Observational ManagementJournal of Urology, VOL. 196, NO. 3, (734-740), Online publication date: 1-Sep-2016.Taneja S (2015) Re: Long-Term Follow-up of a Large Active Surveillance Cohort of Patients with Prostate CancerJournal of Urology, VOL. 194, NO. 5, (1286-1286), Online publication date: 1-Nov-2015.Hawken S, Womble P, Herrel L, Ye Z, Linsell S, Hurley P, Montie J and Miller D (2015) Understanding the Performance of Active Surveillance Selection Criteria in Diverse Urology PracticesJournal of Urology, VOL. 194, NO. 5, (1253-1257), Online publication date: 1-Nov-2015. Volume 193Issue 3March 2015Page: 807-811Supplementary Materials Advertisement Copyright & Permissions© 2015 by American Urological Association Education and Research, Inc.Keywordsprostatic neoplasmsdisease progressionbiopsyprostate-specific antigenoutcome assessmentAcknowledgmentsFrank Stauf and Shoujun Zhao assisted with the study.MetricsAuthor Information Christopher J. Welty More articles by this author Janet E. Cowan More articles by this author Hao Nguyen More articles by this author Katsuto Shinohara Financial interest and/or other relationship with Nihon Mediphysics. More articles by this author Nannette Perez More articles by this author Kirsten L. Greene More articles by this author June M. Chan More articles by this author Maxwell V. Meng Financial interest and/or other relationship with Myriad Genetics, Maximum Medical Solutions and Genomic Health. More articles by this author Jeffry P. Simko More articles by this author Matthew R. Cooperberg Financial interest and/or other relationship with Myriad Genetics, Genomic Health, Genome Dx, Astellas and Dendreon. More articles by this author Peter R. Carroll Financial interest and/or other relationship with Genomic Health International and Myriad Genetics. More articles by this author Expand All Advertisement PDF downloadLoading ..." @default.
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