Metastatic XXXX in @entity1 Initially Treated with Active Surveillance.

@entity1 @entity1486 @entity263 @entity3
PURPOSE: Active surveillance is an approach to low and @entity263 that is designed to decrease overtreatment. Despite close monitoring a small subset of @entity1 progress to @entity3 . We analyzed the clinical and pathological correlates of surveillance in @entity1 who eventually experienced @entity3 . MATERIALS AND METHODS: This was a single center, prospective cohort study. Eligible @entity1 were treated with an expectant approach. The main outcome measure was @entity3 -free survival. Predictive factors for @entity3 were identified. RESULTS: @entity3 developed in 30 of 980 @entity1 , of whom 211 were classified at intermediate risk, including 14 who progressed to @entity3 . Median followup was 6.3 years, median age was 70 years, median @entity1486 was 6.2 ng/ml and median time to @entity3 was 8.9 years. @entity3 developed in bone in 18 @entity1 (60%) and in lymph nodes in 13 (43%). @entity1486 doubling time less than 3 years (HR 3.7, 95% CI 1.4-9.4, p  =  0.0006), Gleason score 7 (HR 3.0, 95% CI 1.2-7.3, p = 0.0018) and a total of 3  or more positive cores (HR 2.7, 95% CI 1.1-6.8, p = 0.0028) were independent predictors of @entity3 . Although the intermediate risk group was at higher risk for @entity3 , those with Gleason score 6 and @entity1486 greater than 10 ng/ml were not at increased risk for @entity3 . @entity3 developed in only 2 @entity1 with Gleason score 6 and neither had surgical pathology grading. CONCLUSION: Active surveillance appears safe in @entity1 at low risk and in select @entity1 at intermediate risk, particularly those with Gleason score 6 and @entity1486 greater than 10 ng/ml. @entity1 with elements of Gleason pattern 4 on diagnostic biopsy are at increased risk for eventual @entity3 when treated with an initial conservative approach.
