Timo Soeterik

35 Active Surveillance: Patient Selection TABLE 2. Reasons for discontinuation of active surveillance in the overall population ( n = 1000) Reason Category Patients (%) Tumour progression ( N = 437) PSA kinetics a 66 (11) DRE b 1 (0) Gleason upgrading 82 (14) Biopsy volume ↑ c 65 (11) MRI findings d 19 (3) Other 10 (2) Combination of two or more 194 (33) Non-oncological ( N = 151) Comorbidity / Age e 41 (7) Patient’s preference 24 (4) Other f 30 (5) Lost to follow-up 56 (10) Total 588 (100) a E.g.: PSADT <3 years and/or PSA >10. b DRE = digital rectal examination. C >50% tumour volume per core or ≥3 positive cores. d E.g.: extracapsular extension, increased tumour volume. e Comorbidity determining patient’s prognosis or reaching an age whereby the clinical relevance of the tumour is not significant. f Including urinary symptoms, or follow-up continued by general practitioner. Time to tumour progression In this cohort, 588 patients discontinued AS (59%), of whom 437 (74%) discontinued due to significant tumour progression. Reasons for discontinuation of AS are listed in Table 2. Figure 2 shows that PRIAS-ineligible patients experienced tumour progression significantly earlier than PRIAS-eligible patients. This increased risk was confirmed by univariate Cox regression analysis (hazard ratio [HR] 1.74, 95% confidence interval [CI] 1.44 - 2.11) (Table 3). In addition, PSAD ≥0.2 ng/ml/ml and positive biopsy cores >2 were both significant predictors of tumour progression. Of these two criteria, PSAD ≥0.2 ng/ ml/ml was the strongest predictor in the multivariate Cox regression model (HR 2.01, 95 CI% 1.67 - 2.44) (Table 3). 2