Investigative and clinical urology · 2026
Predictors of active surveillance discontinuation in prostate cancer: Large Korean multicenter cohort study.
СтатьяМногоцентровое исследованиеПоддержка исследования: вне правительства СШАНазвание и аннотация: Перевод в очереди
Обработка статьи · этапы, ошибки и управление
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Ошибки и ограничения
История · было → стало
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Choi Joongwon, Lee Chung Un, Jeon Seong Soo, Byun Seok Soo, Joung Jae Young, Ahn Hanjong, Cho Jin Seon, Park Sung Woo, Kwon Dong Deuk, Ha U-Syn, Park Jae Young, Kwon Tae Gyun, Jo Jung Ki, Jeong Chang Wook, Kwak Cheol, Prostate Cancer Study Group of the Korean Urological Oncology Society (KUOS)
Аннотация
PURPOSE: Active surveillance (AS) is an established management strategy for favorable-risk prostate cancer (PCa). In real-world practice, decisions to continue AS or active treatment (AT) are influenced by both disease-related and patient-related factors. This study aimed to identify factors associated with the transition from AS to AT in a large multicenter cohort.
MATERIALS AND METHODS: We analyzed 716 patients with PCa managed with AS across 12 institutions. Baseline clinical characteristics, comorbidity burden assessed via the Charlson comorbidity index (CCI), performance status evaluated using the Eastern Cooperative Oncology Group (ECOG) score, and disease-related factors, including prostate-specific antigen (PSA), PSA density (PSAD), and magnetic resonance imaging findings, were collected. Cox proportional hazards regression was used to identify factors associated with conversion to AT.
RESULTS: During a mean follow-up of 28.4 months, 224 patients (31.3%) transitioned from AS to AT, most frequently because of pathologic reclassification (60.3%). In multivariate analysis, maximum core involvement (hazard ratio [HR] 1.015, p=0.003) and PSAD ≥0.10 ng/mL/cm³ (HR 1.478, p=0.044) were independently associated with conversion to AT. Although ECOG performance status and CCI were not statistically significant in multivariate models, patients with poorer functional status or greater comorbidity burden remained on AS rather than proceeding to AT.
CONCLUSIONS: In this large multicenter study, PSAD was the strongest predictor of transition to AT during AS for PCa. Beyond disease-related factors, patient condition also appeared to influence real-world decisions about continuing AS.
MATERIALS AND METHODS: We analyzed 716 patients with PCa managed with AS across 12 institutions. Baseline clinical characteristics, comorbidity burden assessed via the Charlson comorbidity index (CCI), performance status evaluated using the Eastern Cooperative Oncology Group (ECOG) score, and disease-related factors, including prostate-specific antigen (PSA), PSA density (PSAD), and magnetic resonance imaging findings, were collected. Cox proportional hazards regression was used to identify factors associated with conversion to AT.
RESULTS: During a mean follow-up of 28.4 months, 224 patients (31.3%) transitioned from AS to AT, most frequently because of pathologic reclassification (60.3%). In multivariate analysis, maximum core involvement (hazard ratio [HR] 1.015, p=0.003) and PSAD ≥0.10 ng/mL/cm³ (HR 1.478, p=0.044) were independently associated with conversion to AT. Although ECOG performance status and CCI were not statistically significant in multivariate models, patients with poorer functional status or greater comorbidity burden remained on AS rather than proceeding to AT.
CONCLUSIONS: In this large multicenter study, PSAD was the strongest predictor of transition to AT during AS for PCa. Beyond disease-related factors, patient condition also appeared to influence real-world decisions about continuing AS.