Active Surveillance for Taiwanese Men with Localized Prostate Cancer: Intermediate-Term Outcomes and Predictive Factors

Jian-Hua Hong; Ming-Chieh Kuo; Yung-Ting Cheng; Yu-Chuan Lu; Chao-Yuan Huang; Shih-Ping Liu; Po-Ming Chow; Kuo-How Huang; Shih-Chieh Jeff Chueh; Chung-Hsin Chen; Yeong-Shiau Pu

doi:10.5534/wjmh.230107

Active Surveillance for Taiwanese Men with Localized Prostate Cancer: Intermediate-Term Outcomes and Predictive Factors

World J Mens Health. 2023 Sep 26. doi: 10.5534/wjmh.230107. Online ahead of print.

Authors

Affiliations

¹ Department of Urology, National Taiwan University Hospital, Taipei, Taiwan.
² Department of Urology, National Taiwan University Hospital Yunlin Branch, Yunlin, Taiwan.
³ Department of Urology, National Taiwan University Hospital Hsin-Chu Branch, Hsin-Chu, Taiwan.
⁴ Department of Surgical Oncology, National Taiwan University Cancer Center, Taipei, Taiwan.
⁵ Department of Urology, National Taiwan University Hospital, Taipei, Taiwan. chunghsinchen2@ntu.edu.tw.

^# Contributed equally.

PMID: 37853534
DOI: 10.5534/wjmh.230107

Abstract

Purpose: Active surveillance (AS) is one of the management options for patients with low-risk and select intermediate-risk prostate cancer (PC). However, factors predicting disease reclassification and conversion to active treatment from a large population of pure Asian cohorts regarding AS are less evaluated. This study investigated the intermediate-term outcomes of patients with localized PC undergoing AS.

Materials and methods: This cohort study enrolled consecutive men with localized non-high-risk PC diagnosed in Taiwan between June 2012 and Jan 2023. The study endpoints were disease reclassification (either pathological or radiographic progression) and conversion to active treatment. The factors predicting endpoints were evaluated using the Cox proportional hazards model.

Results: A total of 405 patients (median age: 67.2 years) were consecutively enrolled and followed up with a median of 64.6 months. Based on the National Comprehensive Cancer Network (NCCN) risk grouping, 70 (17.3%), 164 (40.5%), 140 (34.6%), and 31 (7.7%) patients were classified as very low-risk, low-risk, favorable-intermediate risk, and unfavorable intermediate-risk PC, respectively. The 5-year reclassification rates were 24.8%, 27.0%, 18.6%, and 25.3%, respectively. The 5-year conversion rates were 20.4%, 28.8%, 43.6%, and 37.8%, respectively. A prostate-specific antigen density (PSAD) of ≥0.15 ng/mL² predicted reclassification (hazard ratio [HR] 1.84, 95% confidence interval [CI] 1.17-2.88) and conversion (HR 1.56, 95% CI 1.05-2.31). A maximal percentage of cancer in positive cores (MPCPC) of ≥15% predicted conversion (15% to <50%: HR 1.41, 95% CI 0.91-2.18; ≥50%: HR 1.97, 95% CI 1.1453-3.40) compared with that of <15%. A Gleason grade group (GGG) of 3 tumor also predicted conversion (HR 2.69, 95% CI 1.06-6.79; GGG 3 vs 1). One patient developed metastasis, but none died of PC during the study period (2,141 person-years).

Conclusions: AS is a viable option for Taiwanese men with non-high-risk PC, in terms of reclassification and conversion. High PSAD predicted reclassification, whereas high PSAD, MPCPC, and GGG predicted conversion.

Keywords: Progression-free survival; Prostate neoplasms; Prostate-specific antigen; Watchful waiting.

Abstract

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