Timo Soeterik

51 Active Surveillance: Follow-up Follow-up intensity and oncological outcome A total of 13 patients developed metastatic PCa (positive lymph nodes and/or bone metastasis) while on AS, and thus missed the window of curability during monitoring. The median duration of AS was 40.8 mo (interquartile range 16.8–59.1). The baseline characteristics for these patients are presented in Table 2. To evaluate the potential association between follow-up intensity and unfavourable oncological outcomes, data for men who developed metastatic PCa during AS follow-up were analysed. The rate of metastasis was significantly higher among men who had low-intensity PSA monitoring (<75% of recommended; Table 3). In the PRIAS-ineligible risk group, the HR for developing metastasis during AS was significantly higher among patients with discordant PSA monitoring than the concordant PSA monitoring group (HR 5.25, 95% CI 1.02 – 27.10). We found no significant correlation between discordant biopsy testing and the rate of metastasis for both the PRIAS-eligible and PRIAS-ineligible subgroups ( p = 0.6). However, among all the patients with discordant biopsy testing, 35% had rapidly increasing PSA levels (defined as PSADT <3 yr), which is significantly lower than for the concordant biopsy group (54%; p < 0.001). In the PRIAS-ineligible group, overall discordant follow-up (discordant PSA monitoring and/or discordant biopsy testing) was also associated with a higher rate of metastatic PCa (2% vs 0%; p = 0.047). TABLE 2. Patients who developed metastasized prostate cancer during AS follow-up Hosp cT PSA Positive cores Grade Group Risk group PRIAS Eligible PSADT (years) Meta- stasis site a AS FU (months) PSA b PRIAS RB c PRIAS 1 T2 23.0 1 1 High risk No 3.4 LN 26 No No T2 11.4 7 2 Intermed No 1.4 LN 19 Yes No 2 T2 7.4 2 1 Low-risk Yes 0.9 Bone 13 Yes Yes T1c 6.3 1 1 Low-risk Yes 9.3 LN 84 Yes Yes 3 T1c 9.0 1 1 Low-risk No 4.6 Bone 49 No Yes 4 T1c 16.0 1 1 Intermed No 0.3 LN 25 No Yes T2b 5.9 2 1 Low-risk Yes 1.9 Bone, LN 39 No No T1c 17.0 1 1 Intermed No 0.9 Bone, LN 11 No Yes 5 T1c 10.0 3 1 Low-risk No 1.3 LN 13 No Yes T1c 5.8 1 1 Low-risk Yes 1.2 LN 7 Yes Yes T1c 4.9 1 1 Low-risk Yes 1.1 LN 4 Yes Yes T1c 7.0 1 1 Low-risk No 7.5 Bone 73 Yes No 6 T2 7.0 1 1 Low-risk Yes 2.1 LN 24 No No a Location where metastastized prostate cancer was found (no distinction between distant or pelvic lymphnodes); b PSA testing performed concordant with the PRIAS protocol; c Repeat biopsies performed concordant with the PRIAS protocol. PSADT = PSA doubling time, FU = follow-up, LN = lymph node. 3