Establishment of Prospective Registry of Active Surveillance for Prostate Cancer: The Korean Urological Oncology Society Database

Gyoohwan Jung; Jung Kwon Kim; Seong Soo Jeon; Jae Hoon Chung; Cheol Kwak; Chang Wook Jeong; Hanjong Ahn; Jae Young Joung; Tae Gyun Kwon; Sung Woo Park; Seok-Soo Byun

doi:10.5534/wjmh.210163

Establishment of Prospective Registry of Active Surveillance for Prostate Cancer: The Korean Urological Oncology Society Database

World J Mens Health. 2023 Jan;41(1):110-118. doi: 10.5534/wjmh.210163. Epub 2022 Feb 3.

Authors

Affiliations

¹ Department of Urology, Seoul National University Bundang Hospital, Seongnam, Korea.
² Department of Urology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
³ Department of Urology, Seoul National University Hospital, Seoul National University School of Medicine, Seoul, Korea.
⁴ Department of Urology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
⁵ Department of Urology, Center for Prostate Cancer, National Cancer Center, Goyang, Korea.
⁶ Department of Urology, Kyungpook National University Chilgok Hospital, Kyungpook National University School of Medicine, Daegu, Korea.
⁷ Department of Urology, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, Yangsan, Korea.
⁸ Department of Medical Device Development, Seoul National University College of Medicine, Seoul, Korea. seoksoo.byeon@gmail.com.

Abstract

Purpose: To establish a prospective registry for the active surveillance (AS) of prostate cancer (PC) using the Korean Urological Oncology Society (KUOS) database and to present interim analysis.

Materials and methods: The KUOS registry of AS for PC (KUOS-AS-PC) was organized in May 2019 and comprises multiple institutions nationwide. The eligibility criteria were as follows: patients with (1) pathologically proven PC; (2) pre-biopsy prostate-specific antigen (PSA) ≤20 ng/mL; (3) International Society of Urological Pathology (ISUP) grade 1 or 2 (no cribriform pattern 4); (4) clinical T stage ≤T2c; (5) positive core ratio ≤50%; and (6) maximal cancer involvement in the core ≤50%. Detailed longitudinal clinical information, including multi-parametric magnetic resonance imaging and disease-specific outcomes, was recorded.

Results: From May 2019 to June 2021, 296 patients were enrolled, and 284 were analyzed. The mean±standard deviation (SD) age at enrollment was 68.7±8.2 years. The median follow-up period was 11.2 months (5.9-16.8 mo). Majority of patients had pre-biopsy PSA ≤10 ng/mL (91.2%), PSA density <0.2 ng/mL² (79.7%), ISUP grade group 1 (94.4%), single positive core (65.7%), maximal cancer involvement in the core ≤20% (78.1%), and clinical T stage of T1c or lower (72.9%). Fifty-two (18.3%) discontinued AS for various reasons. Interventions included radical prostatectomy (80.8%), transurethral prostatectomy (5.8%), primary androgen deprivation therapy (5.8%), radiation (5.8%), and focal therapy (1.9%). The mean±SD time to intervention was 8.9±5.2 months. The reasons for discontinuation included pathologic reclassification (59.6%), patient preference (25.0%), and radiologic reclassification (9.6%). Two (4.8%) patients with pathologic Gleason score upgraded to ISUP grade group 4, no biochemical recurrence.

Conclusions: The KUOS established a successful prospective database of PC patients undergoing AS in Korea, named the KUOS-AS-PC registry.

Keywords: Active surveillance; Database; Prospective registry; Prostate cancer.