Active surveillance program for XXXX : an update of the Johns Hopkins experience.

@entity1 @entity263 @entity5
PURPOSE: We assessed outcomes of @entity1 with @entity263 enrolled in active surveillance. @entity1 AND METHODS: Since 1995, a total of 769 @entity1 diagnosed with @entity263 have been followed prospectively (median follow-up, 2.7 years; range, 0.01 to 15.0 years) on active surveillance. Enrollment criteria were for very-low-risk @entity5 , defined by clinical stage (T1c), prostate-specific antigen density < 0.15 ng/mL, and prostate biopsy findings (Gleason score  <= 6, two or fewer cores with @entity5 , and  <= 50% @entity5 involvement of any core). Curative intervention was recommended on disease reclassification on the basis of biopsy criteria. The primary outcome was survival free of intervention, and secondary outcomes were rates of disease reclassification and exit from the program. Outcomes were compared between @entity1 who did and did not meet very-low-risk criteria. RESULTS: The median survival free of intervention was 6.5 years (range, 0.0 to 15.0 years) after diagnosis, and the proportions of @entity1 remaining free of intervention after 2, 5, and 10 years of follow-up were 81%, 59%, and 41%, respectively. Overall, 255 @entity1 (33.2%) underwent intervention at a median of 2.2 years (range, 0.6 to 10.2 years) after diagnosis; 188 @entity1 (73.7%) underwent intervention on the basis of disease reclassification on biopsy. The proportions of @entity1 who underwent curative intervention (P = .026) or had biopsy reclassification (P < .001) were significantly lower in @entity1 who met enrollment criteria than in those who did not. There were no @entity263 deaths. CONCLUSION: For carefully selected @entity1 , active surveillance with curative intent appears to be a safe alternative to immediate intervention. Limiting surveillance to very-low-risk @entity1 may reduce the frequency of adverse outcomes.
