Early results from South African men with low-risk, clinically localised prostate cancer managed with active surveillance

Abstract

Objective: To report the outcome of active surveillance (AS) offered to men with low-risk prostate cancer (PCa) at Universitas Academic Hospital in Bloemfontein, South Africa.

Methods: Men with PCa with a Gleason score of 6 (3+3) on ≤ 2 needle cores, ≤ cT2a, and prostate-specific antigen (PSA) lower than 10 ng/ml were offered AS. Age, self-reported ethnicity, clinical stage, PSA, PSA density (PSAD), number of positive cores and core percentage were recorded at baseline. Digital rectal examination (DRE), PSA, and PSA kinetics were recorded during follow-up and repeat prostate biopsy done routinely within 12 months of initial diagnosis or if there were unfavourable PSA kinetics. Patients older than 70 years with favourable-intermediate risk were included.

Results: Fifty-four men with median age of 64.8 years (range 43–73 years) were surveilled for low-risk PCa for a median of 31 months (range 7–126 months). Initial median PSA was 7 ng/ml (range 1.1–14.3 ng/ml). Self-reported ethnicity was 35 African (65%), 15 European (28%), one mixed race (2%) and three other (5%). Ethnicity was not associated with adverse reclassification (HR 0.5; p = 0.366). PSAD was the best predictor of reclassification (HR 1.5; p = 0.09). PSAD cut-off was determined with the receiver operatin curves to be 0.13 ng/ml/ml which had a sensitivity of 92.9% and a specificity of 42.5% predicting favourable disease. Upgrade of Gleason score was noted in three (7%) and increased positive cores in 12 (27%) of the 44 men who had a repeat biopsy. Overall, 14 (26%) patients received definitive treatment for their PCa, while 40 (74%) remained on AS.

Conclusion: Based on early results, AS appears to be an appropriate management option for South African men with low-risk PCa and a PSAD ≤ 0.13 ng/ml/ml irrespective of ethnicity.