{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,7]],"date-time":"2026-08-07T16:59:48Z","timestamp":1786121988578,"version":"build-2736575974"},"reference-count":26,"publisher":"MDPI AG","issue":"8","license":[{"start":{"date-parts":[[2026,8,7]],"date-time":"2026-08-07T00:00:00Z","timestamp":1786060800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J. Pers. Med.","JPM"],"abstract":"<jats:p>Background: Active surveillance (AS) represents a cornerstone of personalized medicine in uro-oncology, offering an individualized management strategy for low- and selected favourable intermediate-risk prostate cancer that aligns treatment intensity with patient-specific risk profiles; however, real-world adherence data from southern European academic centres remain scarce. This study aimed to evaluate AS discontinuation rates, reasons for transition to active treatment, and quality of life (QoL) in a single-centre Greek university hospital cohort. Methods: This is an observational retropective cohort study of patients enrolled in an AS protocol at the First Department of Urology, Aristotle University of Thessaloniki, between October 2016 and July 2022. Treatment-free survival (TFS) was estimated using Kaplan\u2013Meier analysis. Associations between AS discontinuation and age at diagnosis, PSA level, and Charlson Comorbidity Index (CCI) were explored using univariable and multivariable Cox proportional hazards regression. QoL, erectile function, and anxiety were assessed cross-sectionally in patients remaining on AS using SF-12, IIEF-6, STAI-6, and MAX-PC. Results: Thirty-six patients were included (32 low-risk; 4 favourable intermediate-risk), with a median age of 69.5 years, median PSA of 6.92 ng\/mL, and median CCI of 3. After a median follow-up of 24 months (IQR 21\u201345), 19 patients (52.8%) transitioned to active treatment; the median time to treatment was 21 months (IQR 17\u201334). Among the 10 patients with a known reason for discontinuation, 6 (31.6% of all discontinued) showed histopathological or clinical disease progression, 3 (15.8%) had a PSA increase alone, and 1 (5.3%) transitioned due to urinary symptoms; the reason was unknown in 9 cases (47.4%). In exploratory Cox regression, PSA \u2265 7.0 ng\/mL was the only factor with complete documented output significantly associated with transition to active treatment (univariable HR 3.70, 95% CI 1.35\u201310.1, p = 0.011; multivariable HR 3.93, 95% CI 1.42\u201310.9, p = 0.008). Cross-sectional QoL assessment in 10 patients remaining on AS demonstrated median scores above established population norms for SF-12 and below clinical anxiety thresholds on STAI-6 and MAX-PC. Conclusions: In this single-centre cohort, AS discontinuation occurred early and at a rate higher than that of established international programmes, consistent with the institution\u2019s initial AS experience. Higher PSA at diagnosis was the only factor with complete analytical documentation to be significantly associated with earlier transition.<\/jats:p>","DOI":"10.3390\/jpm16080420","type":"journal-article","created":{"date-parts":[[2026,8,7]],"date-time":"2026-08-07T08:01:36Z","timestamp":1786089696000},"page":"420","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Active Surveillance for Low- and Favourable Intermediate-Risk Prostate Cancer: A Single-Centre Cohort Study on Discontinuation Rates and Quality-of-Life Outcomes"],"prefix":"10.3390","volume":"16","author":[{"given":"Ioannis","family":"Mykoniatis","sequence":"first","affiliation":[{"name":"First Department of Urology, \u201cG.Gennimatas\u201d General Hospital, Faculty of Medicine, School of Health Sciences, Aristotle University of Thessaloniki, 54635 Thessaloniki, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0003-8929-9204","authenticated-orcid":false,"given":"Athanasios","family":"Papatzelos","sequence":"additional","affiliation":[{"name":"Second Department of General Surgery, \u201cG.Gennimatas\u201d General Hospital, Faculty of Medicine, School of Health Sciences, Aristotle University of Thessaloniki, 54635 Thessaloniki, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0007-2380-7228","authenticated-orcid":false,"given":"Damianos Damon Dejan","family":"Nikolaou Nikolovski","sequence":"additional","affiliation":[{"name":"Department of Cardiothoracic Surgery, General University Hospital of Ahepa, Faculty of Medicine, School of Health Sciences, Aristotle University of Thessaloniki, 54636 Thessaloniki, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6164-1045","authenticated-orcid":false,"given":"Asterios","family":"Symeonidis","sequence":"additional","affiliation":[{"name":"First Department of Urology, \u201cG.Gennimatas\u201d General Hospital, Faculty of Medicine, School of Health Sciences, Aristotle University of Thessaloniki, 54635 Thessaloniki, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0009-2566-5125","authenticated-orcid":false,"given":"Christos","family":"Roidos","sequence":"additional","affiliation":[{"name":"First Department of Urology, \u201cG.Gennimatas\u201d General Hospital, Faculty of Medicine, School of Health Sciences, Aristotle University of Thessaloniki, 54635 Thessaloniki, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4964-1119","authenticated-orcid":false,"given":"Chrysovalantis","family":"Toutziaris","sequence":"additional","affiliation":[{"name":"First Department of Urology, \u201cG.Gennimatas\u201d General Hospital, Faculty of Medicine, School of Health Sciences, Aristotle University of Thessaloniki, 54635 Thessaloniki, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2187-325X","authenticated-orcid":false,"given":"Ioannis","family":"Vakalopoulos","sequence":"additional","affiliation":[{"name":"First Department of Urology, \u201cG.Gennimatas\u201d General Hospital, Faculty of Medicine, School of Health Sciences, Aristotle University of Thessaloniki, 54635 Thessaloniki, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2671-571X","authenticated-orcid":false,"given":"Petros","family":"Sountoulides","sequence":"additional","affiliation":[{"name":"First Department of Urology, \u201cG.Gennimatas\u201d General Hospital, Faculty of Medicine, School of Health Sciences, Aristotle University of Thessaloniki, 54635 Thessaloniki, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,8,7]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"148","DOI":"10.1016\/j.eururo.2024.03.027","article-title":"EAU-EANM-ESTRO-ESUR-ISUP-SIOG Guidelines on Prostate Cancer-2024 Update. Part I: Screening, Diagnosis, and Local Treatment with Curative Intent","volume":"86","author":"Cornford","year":"2024","journal-title":"Eur. Urol."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"374","DOI":"10.1093\/jnci\/djp001","article-title":"Lead time and overdiagnosis in prostate-specific antigen screening: Importance of methods and context","volume":"101","author":"Draisma","year":"2009","journal-title":"J. Natl. Cancer Inst."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"1075","DOI":"10.1016\/S0140-6736(21)00950-8","article-title":"Prostate cancer","volume":"398","author":"Sandhu","year":"2021","journal-title":"Lancet"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"1119","DOI":"10.1016\/j.annonc.2020.06.011","article-title":"Prostate cancer: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up","volume":"31","author":"Parker","year":"2020","journal-title":"Ann. Oncol."},{"key":"ref_5","unstructured":"National Comprehensive Cancer Network (2026, March 03). NCCN Clinical Practice Guidelines in Oncology: Prostate Cancer. Version 2.2025. Available online: https:\/\/www.nccn.org\/professionals\/physician_gls\/pdf\/prostate.pdf."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"10","DOI":"10.1097\/JU.0000000000002757","article-title":"Clinically Localized Prostate Cancer: AUA\/ASTRO Guideline, Part I","volume":"208","author":"Eastham","year":"2022","journal-title":"J. Urol."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"1561","DOI":"10.1001\/jama.2024.6695","article-title":"Long-Term Outcomes in Patients Using Protocol-Directed Active Surveillance for Prostate Cancer","volume":"331","author":"Newcomb","year":"2024","journal-title":"JAMA"},{"key":"ref_8","first-page":"49","article-title":"The era of active surveillance for low-risk prostate cancer is here","volume":"69","author":"Sountoulides","year":"2016","journal-title":"Arch. Esp. Urol."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"e2425050","DOI":"10.1001\/jamanetworkopen.2024.29760","article-title":"Trends in Active Surveillance for Men With Intermediate-Risk Prostate Cancer","volume":"7","author":"Diven","year":"2024","journal-title":"JAMA Netw. Open"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"903","DOI":"10.1097\/JU.0000000000001903","article-title":"Factors Associated with Discontinuation of Active Surveillance among Men with Low-Risk Prostate Cancer: A Population-Based Study","volume":"206","author":"Timilshina","year":"2021","journal-title":"J. Urol."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"523","DOI":"10.1016\/j.eururo.2018.10.025","article-title":"Reasons for Discontinuing Active Surveillance: Assessment of 21 Centres in 12 Countries in the Movember GAP3 Consortium","volume":"75","author":"Ji","year":"2019","journal-title":"Eur. Urol."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"96","DOI":"10.1111\/bju.15136","article-title":"Personalised Biopsy Schedules Based on Risk of Gleason Upgrading for Patients With Low-Risk Prostate Cancer on Active Surveillance in the PRIAS Study: An Update","volume":"127","author":"Tomer","year":"2021","journal-title":"BJU Int."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"1255","DOI":"10.1016\/j.euo.2024.05.008","article-title":"Patient-Reported Outcome Measures and Experience Measures After Active Surveillance Versus Radiation Therapy Versus Radical Prostatectomy for Prostate Cancer: A Systematic Review of Prospective Comparative Studies","volume":"7","author":"Alberti","year":"2024","journal-title":"Eur. Urol. Oncol."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"12845","DOI":"10.1038\/s41598-022-17224-w","article-title":"Impact of Active Surveillance for Prostate Cancer on the Risk of Depression and Anxiety","volume":"12","author":"Sypre","year":"2022","journal-title":"Sci. Rep."},{"key":"ref_15","first-page":"298","article-title":"Long-Term Cancer-Specific Anxiety in Men Undergoing Active Surveillance for Prostate Cancer: Findings From a Large Prospective Cohort","volume":"37","author":"Marzouk","year":"2019","journal-title":"Urol. Oncol."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"220","DOI":"10.1097\/00005650-199603000-00003","article-title":"A 12-Item Short-Form Health Survey: Construction of scales and preliminary tests of reliability and validity","volume":"34","author":"Ware","year":"1996","journal-title":"Med. Care"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"55","DOI":"10.1186\/1477-7525-5-55","article-title":"Validity of SF-12 summary scores in a Greek general population","volume":"5","author":"Kontodimopoulos","year":"2007","journal-title":"Health Qual. Life Outcomes"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"822","DOI":"10.1016\/S0090-4295(97)00238-0","article-title":"The international index of erectile function (IIEF): A multidimensional scale for assessment of erectile dysfunction","volume":"49","author":"Rosen","year":"1997","journal-title":"Urology"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"346","DOI":"10.1016\/S0090-4295(99)00099-0","article-title":"Diagnostic evaluation of the erectile function domain of the international index of erectile function","volume":"54","author":"Cappelleri","year":"1999","journal-title":"Urology"},{"key":"ref_20","first-page":"386","article-title":"Anxiety and Distress During Active Surveillance for Early Prostate Cancer","volume":"105","author":"Roobol","year":"2009","journal-title":"BJU Int."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"245","DOI":"10.1111\/j.2044-8260.1983.tb00610.x","article-title":"Some norms and reliability data for the State-Trait Anxiety Inventory and the Zung Self-Rating Depression scale","volume":"22","author":"Knight","year":"1983","journal-title":"Br. J. Clin. Psychol."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"2910","DOI":"10.1002\/cncr.11386","article-title":"The memorial anxiety scale for prostate cancer: Validation of a new scale to measure anxiety in men with prostate cancer","volume":"97","author":"Roth","year":"2003","journal-title":"Cancer"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"1147","DOI":"10.1097\/JU.0000000000001937","article-title":"Factors Associated with Time to Conversion from Active Surveillance to Treatment for Prostate Cancer in a Multi-Institutional Cohort","volume":"206","author":"Cooley","year":"2021","journal-title":"J. Urol."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"4","DOI":"10.1016\/j.euo.2022.09.001","article-title":"Long-term Health-related Quality of Life in Patients on Active Surveillance for Prostate Cancer: A Systematic Review","volume":"6","author":"Thompson","year":"2023","journal-title":"Eur. Urol. Oncol."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"1151","DOI":"10.1016\/j.euf.2021.06.008","article-title":"Prospective Longitudinal Health-related Quality of Life Analysis of the Finnish Arm of the PRIAS Active Surveillance Cohort: 11 Years of Follow-up","volume":"8","author":"Lokman","year":"2022","journal-title":"Eur. Urol. Focus."},{"key":"ref_26","first-page":"123","article-title":"Quality of Life in Low-Risk Prostate Cancer Under Active Surveillance or Following Radical Treatments: The START Cohort Study","volume":"28","author":"Rosato","year":"2025","journal-title":"Prostate Cancer Prostatic Dis."}],"container-title":["Journal of Personalized Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2075-4426\/16\/8\/420\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,7]],"date-time":"2026-08-07T08:19:31Z","timestamp":1786090771000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2075-4426\/16\/8\/420"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,8,7]]},"references-count":26,"journal-issue":{"issue":"8","published-online":{"date-parts":[[2026,8]]}},"alternative-id":["jpm16080420"],"URL":"https:\/\/doi.org\/10.3390\/jpm16080420","relation":{},"ISSN":["2075-4426"],"issn-type":[{"value":"2075-4426","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,8,7]]}}}