INTRODUCTION
Adherence to follow-up schedule in Active Surveillance (AS) may favor early detection of significant prostate cancers and AS safety.
OBJECTIVE
To report compliance (compl) rates in AS for prostate cancer (Pca) in a single institute setting, including 2 protocols (P1 and P2), which differs also as number of scheduled biopsies.
MATERIALS AND METHODS
From 2005, 818 men were prospectively monitored. Both protocols scheduled PSA every 3 mos, digital rectal examination (DRE) every 6 mos; biopsies were provided at yrs 1,4,7 in P1, and at yrs 1,2,4,6,8 in P2. Patients (Pts) were advised to switch to active treatment if disease stage and/or grade reclassification occurred (>cT2c, GPS>3+3, >2 cores positive (P1) or >25% cores positive (P2); PSA doubling time (DT) <3yrs).
We analyzed compl to PSA and biopsy along 3 time frames: short (<=2yrs), medium (2 to 4yrs) and long (5 to 8yrs). Compl to PSA monitoring was defined as having at least 3 PSA per year.
RESULTS
818 (530 in P1 and 288 in P2) pts were included. Median follow-up was 59 mos (range 4.1–145.2 mos). 452 (55.3%) pts are still on AS.
585/818 pts have at least completed 1 yr of follow-up (400 P1, 185 P2) and were evaluable for PSA and biopsy compl.
Compl (figure 1) ranged between 85-92% for PSA and between 88-98% for biopsy. Compl rates are always higher in P1 vs P2, with general decrease in long AS pts (especially for biopsy compl). A further sub-analysis revealed lower compl rates in pts enrolled in AS before 2010. This could be partly explained by an improvement since 2010 when the AS clinical staff was joined by a research nurse and a data manager, who contact pts, record PSA, calculate PSADT, book biopsy and strict monitor visits.
CONCLUSIONS
Compl with AS protocols for PCa in a large AS cohort was evaluated. We observed excellent compl with PSA monitoring, especially after activation of strict control of AS management. Adherence to biopsy monitoring protocol decreases after long time in AS, reasonably due to reluctance of patients, and clinicians too, to perform further biopsies in men with a long favorable AS history and a not rising PSA.
