Background Controversy exists concerning the management of clinically localized prostate cancer. Active surveillance has been proposed as a method of managing men with low volume, low grade prostate disease. To gain insights concerning the outcomes associated with this strategy, we reviewed the clinical course of patients electing active surveillance at our institution during the PSA era.
Methods We reviewed clinical records of patients who elected active surveillance at the University of Connecticut Health Center. Patients were selected for inclusion if they had elected active surveillance for greater than 6 months after prostate cancer diagnosis. Data concerning patients’ age at time of diagnosis, comorbidities, date of diagnosis, TRUS biopsy results, PSA progression, date of last contact, date of treatment, reason for choosing to pursue treatment, and treatment chosen were collected. Institutional Review Board approval was obtained prior to initiation of study. This study was approved by the DPH HIC. Certain data used in this study were obtained from the Connecticut Department of Public Health. The authors assume full responsibility for analyses and interpretation of these data.
Results A total of 70 patients were identified who elected active surveillance with a mean age at time of diagnosis of 69 (range 50-87). The average PSA at the time of diagnosis was 9.1 and 81% of men had Gleason sums less than 7. Patients electing active surveillance had minimal comorbidities. Six patients have died on active surveillance of causes unrelated to prostate cancer (10, 60, 84, 96, 96, 132 months following diagnosis). Twenty-three patients obtained further treatment for their prostate cancer (12 hormone therapy, 7 prostatectomy, 4 radiation). Patients elected further treatment primarily because of PSA elevation or a change in TRUS biopsy. Four patients who elected treatment died of causes unrelated to prostate cancer (84, 120, 144, 156 months after diagnosis). One patient electing hormonal therapy 24 months after diagnosis died of prostate cancer 12 months later. Figure 1 shows a Kaplan Meier curve for the probability of remaining on active surveillance.

Conclusions Less than 50% of patients initially electing active surveillance chose therapy for prostate cancer within seven years of diagnosis. The primary reasons to seek aggressive treatment were an increase in PSA values or a change in biopsy findings. Active surveillance appears to be an appropriate treatment for properly selected patients.