Updated clinical results of active surveillance of very-low-risk prostate cancer in Korean men: 8 years of follow-up
- Affiliated Author(s)
- 김천일; 정원호; 하지용; 김병훈; 박철희
- Alternative Author(s)
- Jung, Won Ho; Park, Choal Hee; Kim, Chun Il; Kim, Byung Hoon; Ha, Ji Yong
- Journal Title
- Invastigative and Clinical Urology
- Issued Date
- Needle biopsy; Prostate-specific antigen; Prostatic neoplasms; Watchful waiting
- Purpose: Update and reanalysis of our experience of active surveillance (AS) for prostate cancer (PCa) in Korea.
Materials and Methods: A prospective, single-arm, cohort study was initiated in January 2008. Patients were selected according
to the following criteria: Gleason sum ≤6 with single positive core with ≤30% core involvement, clinical stage≤T1c, prostate-specific
antigen (PSA)≤10 ng/mL, and negative magnetic resonance imaging (MRI) results. Follow-up was by PSA measurement every
6 months, prostate biopsies at 1 year and then every 2–3 years, and MRI every year.
Results: A total of 80 patients were treated with AS. Median follow-up was 52 months (range, 6–96 months). Of them, 39 patients
(48.8%) discontinued AS for various reasons (17, disease progression; 9, patient preference; 10, watchful waiting due to old age; 3,
follow-up loss; 2, death). The probability of progression was 14.0% and 42.9% at 1 and 3 years, respectively. Overall survival was
97.5%. PCa-specific survival was 100%. Progression occurred in 5 of 7 patients (71.4%) with a prostate volume less than 30 mL, 7 of
40 patients (17.5%) with a prostate volume of 30 to 50 mL, and 5 of 33 patients (15.2%) with a prostate volume of 50 mL or larger.
There were 8 detectable positive lesions on follow-up MRI. Of them, 6 patients (75%) had actual progressed disease.
Conclusions: Small prostate volume was associated with a tendency for cancer progression. MRI was helpful and promising for
managing AS. Nevertheless, regular biopsies should be performed. AS is a safe and feasible treatment option for very-low-risk PCa
in Korea. However, AS should continue to be used in carefully selected patients.
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