To report oncologic outcomes of active surveillance at a single non-academic institution adopting the standardized Prostate Cancer Research International Active Surveillance (PRIAS) protocol.
Competing risk analyses estimated the incidence of overall mortality, metastases, conversion to treatment and grade reclassification. The incidence of reclassification and adverse pathologic findings at radical prostatectomy were compared between patients fulfilling all PRIAS inclusion criteria versus those not fulfilling at least one.
We analyzed 341 men with grade group 1 prostate cancer followed on active surveillance between 2010 and 2022. There were no prostate cancer deaths, two patients developed distant metastases and were alive at the end of the study period. The 10-year cumulative incidence of metastases was 1.9% (95% CI 0.33-6.4%). A total of 111 men were reclassified, and 127 underwent definitive treatment. Men not fulfilling at least one PRIAS inclusion criteria (n=43) had higher incidence of reclassification (subdistribution hazards ratio 1.73, 95% CI 1.07-2.81, p=0.03), but similar rates of adverse pathologic findings at radical prostatectomy.
Metastases in men on active surveillance at a non-academic institution are as rare as those reported in established international cohorts. Men followed without stringent inclusion criteria should be counselled of higher incidence of reclassification, and reassured they can expect rates of adverse pathologic findings comparable to those fulfilling all criteria. Therefore, active surveillance should be proposed to all men with low-grade prostate cancer regardless of whether they are followed at academic institutions or smaller community hospitals.
BJU international. 2023 Dec 14 [Epub ahead of print]
Riccardo Leni, Marco Roscigno, Paolo Barzaghi, Giovanni La Croce, Michele Catellani, Antonino Saccà, Mario de Angelis, Francesco Montorsi, Alberto Briganti, Luigi Filippo Da Pozzo
Department of Urology and Division of Experimental Oncology, IRCCS San Raffaele Scientific Institute, Milan, Italy., Department of Urology, ASST Papa Giovanni XXIII, Bergamo, Italy.