Retrospective audit of active surveillance practice in favourable risk prostate cancer in a local patient cohort

Abstract

BACKGROUND: The aim of this audit is to review the local monitoring of favourable risk prostate cancer (CaP) patients under active surveillance (AS), the primary endpoints being determining cancer-specific survival (CSS), rate of development of metastatic disease, mortality and percentage of patients who required definitive treatment.

METHODS: Men diagnosed with CaP between January 2010 and December 2015 who were candidates for AS were included. Prostate specific antigen (PSA) values, imaging and histology results were recorded. The standard used is European Association of Urology 2021 guideline on AS and landmark papers published in the past decade.

RESULTS: 56.3% of patients had biochemical, radiological or histological progression. Overall survival is 85.4%. CSS is 97.9%. Mortality is 2.1%, whilst 4.2% of patients developed metastatic disease. From the audited population, 36.4% eventually required radical treatment. There is a statistically significant difference between the vital status groups’ PSA level at diagnosis (p=0.002), PSA velocity (p=0.0001) and PSA density (p=0.029). The mean length of follow-up is 6.33years.

CONCLUSION: The high CSS rate is testimony to the success of local AS programs. The wide range of cancer stage, grade and PSA levels of patients chosen for AS should raise the question of whether our selection criteria for AS are stringent enough.