At what stage are we in active surveillance for localized prostate cancer? Our clinical experience

Abstract

Objective: Prostate cancer (PCa) is the most common malignancy in men and early diagnosis can be made by screening. Active surveillance (AS) is one of the options for disease management in patients with low-risk prostate cancer (LRPC). In this study, we aimed to evaluate our clinical experience in AS for prostate cancer. Material and Methods: Data from 1650 patients who were diagnosed with PCa in the period between January 2014 and December 2019, were retrospectively reviewed. Inclusion criteria were defined as being under 75 years of age and having a 10-year life expectancy, being at clinical stages of T1-T2a, having a PSA level of <10 ng/dl, having positive biopsy cores of ≤2, and having a Gleason score of ≤6 as the result of the pathological examination of the biopsy specimen. Patients not meeting any of the inclusion criteria were excluded from the study. Results: After the inclusion and exclusion criteria, 176 patients agreed to undergo AS and were included in the study. The mean follow-up duration was 25.2 ± 13 months. A total of 57 patients (32.3%) left the AS program to undergo definitive treatment. Definitive treatment was radical prostatectomy in 38 (65.5%) patients, radiotherapy in 18 (31%) patients, and hormonotherapy in one (1.7%) patient. Conclusion: AS is a method that helps avoid the complications of definitive treatment in LRPC patients. It can be used as an alternative option to definitive treatment in the management of these patients. However, it should not be forgotten that pathological upgrades may occur in 30% of AS patients, indicating the need for definitive treatment. Keywords: prostate cancer, active surveillance, low-risk prostate cancer