Active Surveillance of Prostate Cancer is a Viable Option for Men Younger than 60 Years
| Autor: | Laurence Klotz, Michael L. Blute, Danny Vesprini, Anthony L. Zietman, Jason A. Efstathiou, Adam S. Feldman, Glen W. Barrisford, Andrew Loblaw, Keyan Salari, Mark A. Preston, Douglas M. Dahl, David Kuppermann |
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| Rok vydání: | 2019 |
| Předmět: |
Male
medicine.medical_specialty Urology medicine.medical_treatment 030232 urology & nephrology MEDLINE Active surveillance of prostate cancer 03 medical and health sciences 0302 clinical medicine Internal medicine medicine Humans Watchful Waiting Aged Retrospective Studies Prostatectomy business.industry Follow up studies Age Factors Prostatic Neoplasms Retrospective cohort study Middle Aged Prostate-specific antigen business Watchful waiting Follow-Up Studies |
| Zdroj: | The Journal of urology. 201(4) |
| ISSN: | 1527-3792 |
| Popis: | At most centers strict age criteria are lacking for eligibility for active surveillance of prostate cancer. Younger men are often counseled to undergo definitive treatment despite limited data on the outcomes of active surveillance in younger men. We compared clinical characteristics and outcomes in men who enrolled in active surveillance at age less than 60 vs 60 years old or older.We retrospectively reviewed the records of 2 institutional cohorts of a total of 2,084 men in whom prostate cancer was managed by active surveillance between 1995 and 2016. We compared outcomes in men who began active surveillance at age 60 vs 60 years or older using the Kaplan-Meier method and Cox proportional hazards regression.We identified 417 and 1,667 men who began active surveillance at younger than 60 and 60 years old or older, respectively, who met study inclusion criteria. At a median followup of 6.2 years we found no significant difference between men younger than 60 and 60 years old or older in the 5-year rates of biopsy progression-free survival (83% vs 83%), treatment-free survival (74% vs 71%), metastasis-free survival (99.7% vs 99.0%) or prostate cancer specific survival (100% vs 99.7%). Of the younger men 131 (31%) ultimately underwent treatment, including for pathological progression in 67% and prostate specific antigen progression in 18%. On multivariate analysis significant predictors of biopsy progression and progression to treatment among younger men were 20% or greater involvement of any core on diagnostic biopsy (HR 2.21, p = 0.003) and prostate specific antigen density 0.15 ng/ml/ml or greater (HR 1.93, p = 0.01).Active surveillance is a viable option in select men younger than 60 years with low volume, low risk prostate cancer. However, patients must be surveyed closely and understand the significant likelihood of ultimately requiring treatment. |
| Databáze: | OpenAIRE |
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