Back to 2015 Joint Annual Meeting

Introduction: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 our AS cohort of men under age 60.
Materials & Methods:We reviewed our single-institutional AS database of 990 men diagnosed between 1997-2014 to identify 177 men under age 60. Guidelines for inclusion in AS at our institution include Gleason ≤ 6 (Gleason 3+4 in select patients with low volume), ≤3/12 cores positive with ≤20% in each core, PSA <10.
Results:At diagnosis, median age was 56 years(IQR 53.1-57.7) and median PSA was 4.47 ng/mL(IQR 3.00-5.60), with 173 of 177 below 10 ng/mL. 176 of 177 had Gleason 6 and 1 of 177 had Gleason 3+2=5. 92.7% (164/177) were T1c, 6.7% (12/177) T2a, and 0.6% (1/177) T1a. With a median follow-up of 4.4 years (range:0.5-17.0;IQR:2.8-6.1), 85.9% (152/177) had a repeat biopsy with 61.8%(94/152) showing prostate cancer, 25.7% (39/152) benign, 7.2%(11/152) with PIN, and 5.3%(8/152) with atypia. Kaplan Meier actuarial freedom-from-treatment was 69.6% at 5 years. 28.3%(51) of all patients progressed to treatment for the following reasons: 68.6%(35/51) pathologic progression, 17.6%(9/51) PSA progression, 11.8%(6/51) patient preference, 2.0%(1/51) other reasons. Among treated patients, 72.5%(37/51) had surgery, 19.6%(10/51) had external beam radiation, and 7.8%(4/51) had brachytherapy. On pathologic review after surgery, 83.8%(31/37) were pT2, and 16.2%(6/37) pT3.
Conclusions:Active surveillance is a reasonable option for carefully selected men under 60 with low risk prostate cancer. Patients must be surveyed closely and understand the risk of ultimately needing treatment.