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Introduction: PSA screening has resulted in a significant increase in the diagnosis of low risk prostate adenocarcinoma (PCa). Treating these cancers would cause significant morbidity with radical treatment. Active surveillance (AS) is an alternative to radical treatment for these cancers and to monitor them with the intent to treat radically once the cancer progresses. Methods: In this retrospective study, patients treated at the Manitoba Prostate Cancer with an active diagnosis of Prostate Adenocarcinoma with Gleason ≤ 3+4, multiple biopsies, ≤t2b (with one exception), and PSA <20 (two exceptions) were analyzed for changes in PSA , PSA doubling time, PSA density, Prostate volume changes, triggers for biopsy, triggers for treatment, types of treatment, changes in Gleason grading, pathological changes such as cores involved, percent minimum and maximum. Further biopsy intervals were assessed, follow­up time, and surgical pathology if available. Consent was obtained. Results: Manitoba Prostate Center has 194 patients on Active Surveillance; 64 of whom received treatment. Of the treated patients the median age was 65 with an average follow up of 5.3 years, and average of 2.6 biopsies each. Median interval to first biopsy was 9.5 months, and 12 between all biopsies. Majority of patients had Gleason 3+3 when started on active surveillance. 68.8 percent had a final Gleason of ≥ 3+4. 64.6 percent of initial biopsies were triggered by PSA, and 81.3 percent of treatment was triggered by biopsy results, i.e. Gleason progression or volume changes. There were zero PCa related deaths in the treated group. Conclusion: The Manitoba Prostate Center treatment data of Active surveillance is consistent with what is found in the literature. AS is safe as there were zero PCa deaths over the 5 year follow up. Surgical patients were younger, PSA changes trigger surveillance biopsies, and biopsy results trigger treatment more than anxiety.