الفهرس 
Comparing management strategies of patients with low risk prostate cancer under active surveillance
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Abstract
Introduction & objectives: Controversies regarding appropriate management of patients with low risk prostate cancer under active surveillance exist. We aimed at studying the value of doing routine protocol biopsies vs. doing biopsy only for a cause for those patients. Materials & methods: Patients undergoing active surveillance for low risk prostate cancer were included in the study. Patients were divided according to the treating physician preference into protocol biopsy (12-18 monthly biopsy), and for- cause only biopsy (change in prostate exam or elevation in serum PSA) groups. All patients were further subdivided according to the NCCN (National Comprehensive Cancer Network) risk stratification into very low risk and low risk groups. Wilcox, Fisher exact, and log-rank test were used for statistical analysis. Primary outcome measures were progression-free survival (PFS) and secondary outcome measures were metastasis-free survival and the need for conversion to treatment. Results: A total 139 patients were included in the study; 59 patients in protocol biopsy and 80 patients in for-cause only biopsy groups. Mean follow-up was 39 and 57 months, respectively (p<0.001). Median PSA at diagnosis was 4.7 and 5.4, respectively (p=0.053). All patients were T1c stage, and all the patients had a Gleason 6 disease on the first biopsy. Seven (12.3%) and 11 (13.8%) patients were converted to treatment, respectively (p=0.97). Patients under for-cause only biopsy had higher 5-year PFS than patients under protocol biopsy (79% vs. 41%; p=0.003); meanwhile, none developed metastatic disease while on either surveillance protocols, and all patients converted to surgical treatment had organ- confined disease and none developed biochemical recurrence. Further subdividing the patients according to the NCCN risk stratification into very low and low risk 10 groups did not show statistically significant differences among all the subgroups in their baseline characteristics or oncologic follow-up