BACKGROUND.Active surveillance followed by selective treatment for men who have evidence of disease progression may be an option for select patients with early‐stage prostate cancer. In this article, the authors report their experience in a contemporary cohort of men with prostate cancer who were managed with active surveillance.METHODS.All men who were managed initially with active surveillance were identified through the authors' institutional database. Selection criteria for active surveillance included: prostate‐specific antigen (PSA) <10 ng/mL, biopsy Gleason sum ≤6 with no pattern 4 or 5, cancer involvement of <33% of biopsy cores, and clinical stage T1/T2a tumor. Patients were followed with PSA measurements and digital rectal examination every 3 to 6 months and with transrectal ultrasound at 6‐ to 12‐month intervals. Beginning in 2003, patients also underwent repeat prostate biopsy at 12 to 24 months. The primary outcome measured was active treatment. Evidence of disease progression, defined as an increase in rebiopsy Gleason sum or significant PSA velocity changes (>0.75 ng/mL per year), was a secondary outcome. Chi‐square and log‐rank tests were used to compare groups. The association between clinical characteristics and receipt of active treatment was analyzed by using Cox proportional hazards regression.RESULTS.Three hundred twenty‐one men (mean age [±standard deviation]: 63.4 ± 8.5 years) selected active surveillance as their initial management. The overall median follow‐up was 3.6 years (range, 1–17 years). The initial mean PSA level was 6.5 ± 3.9 ng/mL. One hundred twenty men (37%) met at least 1 criterion for progression. Overall, 38% of men had higher grade on repeat biopsy, and 26% of men had a PSA velocity >0.75 ng/mL per year. Seventy‐eight men (24%) received secondary treatment at a median 3 years (range, 1–17 years) after diagnosis. Approximately 13% of patients with no disease progression elected to obtain treatment. PSA density at diagnosis and rise in Gleason score on repeat biopsy were associated significantly with receipt of secondary treatment. The disease‐specific survival rate was 100%.CONCLUSIONS.Selected individuals with early‐stage prostate cancer may be candidates for active surveillance. Specific criteria can be and need to be developed to select the most appropriate individuals for this form of management and to monitor disease progression. A small attrition rate can be expected because of men who are unable or unwilling to tolerate surveillance. Cancer 2008. © 2008 American Cancer Society.

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Tumor margins were positive in 32/176 IMRs (18%) compared to 50/76 of DRs (66%), respectively ( p < 0.000). There were 56/252 (22%) postoperative complications, consisting mostly of infections requiring antibiotic treatment (64%). The complication rate was higher in patients with DR compared to IMR (36% vs. 16%, p = 0.001). There was no difference, however, in the need for unplanned re-operation (8% vs. 4%).Conclusion: Despite the higher risk of minor complications, DR allows reexcision in case of tumor-positive margins without dismantling the reconstruction. Multidisciplinary pre-operative risk assessment successfully selected cases with an increased risk of positive margins.No conflict of interest. 200Poster Importance of intraoperatory surgical margin assessment for positive margin diagnosis in breast cancer-conserving surgery

INTRODUCTION AND OBJECTIVES: Active surveillance (AS) is an increasingly utilized management strategy for men with prostate cancer (PCa). The suitability of younger patients for initial AS has been questioned on the basis of eventual treatment necessity and concerns of safety, however the role of age on surveillance outcomes is not well defined.METHODS: We identified all men enrolled in AS at our institution between 1990-2015 with a minimum follow up of 6 months. The recommended surveillance protocol consisted of quarterly PSA monitoring, transrectal ultrasonography and periodic prostate biopsy. We examined the association of younger patient age (60 years) with risk of biopsy progression, defined by increase in Gleason score (GS) or tumor volume, as well as rates of treatment, and pathological and biochemical outcomes following delayed radical prostatectomy (RP). Descriptive statistics, and multivariate Cox proportional hazards regression models were used to examine the association of age, adjusted for relevant clinical and demographic characteristics.RESULTS: 1,443 consenting patients were followed for a median of 49 months . Median age at enrollment was 63 years (IQR 57-68) including 599 (42%) 60 and 834 (58%) >60 years. GS at diagnosis was 3+3 in 1,258 patients (89%) and 3+4 in 137 (10%). 3 and 5-year upgrade-free rates were 73% and 55% for men 60 compared with 64% and 48% for men >60 (p<0.01). Rates of treatment were not significantly different between younger (65%) and older patients (64%) at five years (p¼0.84), although men 60 were more likely to receive subsequent RP (n¼158, 26%) versus radiation (n¼42, 7%). On Cox regression analysis age 60 was independently associated with decreased risk of biopsy upgrade (HR 0.67, 95% CI 0.55-0.83) and biopsy progression (HR 0.76, 95% CI 0.64-0.90). No significant association was seen between younger age and risk of treatment or risk of recurrence following delayed RP.CONCLUSIONS: Age 60 years was associated with decreased risk of biopsy progression during AS yet similar rates of definitive treatment and recurrence-free survival after RP. Appropriately risk stratified younger men represent surveillance candidates with comparatively favorable longitudinal biopsy characteristics. Additional follow up is needed to confirm these findings.