Investig Clin Urol.  2021 Jul;62(4):430-437. 10.4111/icu.20200504.

The clinical impact of strict criteria for active surveillance of prostate cancer in Korean population: Results from a prospective cohort

• Suh J
• Yuk HD
• Kang M
• Tae BS
• Ku JH
• Kim HH
• Kwak C
• Jeong CW

• KMID: 2516923
• DOI: http://doi.org/10.4111/icu.20200504

Abstract

Purpose
To evaluate the clinical impact of strict selection criteria for active surveillance (AS) of prostate cancer in a Korean population.
Materials and Methods
A single-center, prospectively collected AS cohort from December 2016 to February 2019 was used. Following pre-determined criteria, patients were categorized into “strict AS” and “non-strict AS” groups. Clinicopathological progression-free survival (PFS) and treatment-free survival (TFS) of the two groups were compared using the Kaplan–Meier curve and logrank test. Age-adjusted hazard ratios for clinicopathological progression was calculated using Cox proportional regression analysis.
Results
Of 54 eligible patients, 25 and 29 were assigned to “strict AS” and “non-strict AS,” respectively. Clinicopathological progression and definitive treatment rates were 24.0% (6 of 25 patients) vs. 51.7% (15 of 29 patients) and 32.0% (8 of 25 patients) vs. 62.1% (18 of 29 patients) in “strict AS” and “non-strict AS” groups. Progress to high-risk cancer (pathologic T3 or surgical Gleason Grade 2 over) in radical prostatectomy was higher in “non-strict AS” than “strict AS”. PFS (mean 34.6±2.9 mo vs. 22.6±2.7 mo; p=0.025) and TFS (mean 31.8±3.2 mo vs. 19.6±2.4 mo; p=0.018) favor the “strict AS” group than “non-strict AS” group. Age-adjusted hazard ratio for clinicopathological progression of strict criteria was 0.36 (95% confidence interval, 0.14–0.94; p=0.04).
Conclusions
PFS and TFS were better in the “strict AS” group than in the “non-strict AS” group. This finding should be informed to relevant patients during decision making and considered in Korean guidelines.

Keyword

Active surveillance; Patient selection; Prostate neoplasms