Patients with favorable intermediate-risk prostate cancer (PCa) who choose active surveillance may have low death rates, according to new study findings presented during the American Urological Association 2020 Virtual Experience.  

Investigators led by Paige Kuhlmann, MD, of Cedars Sinai Medical Center in Los Angeles, estimated the risk for prostate cancer-specific mortality (PCSM) after active surveillance by assuming it is 50% to 5-fold higher than the rate of PCSM after radical prostatectomy (RP). The landmark ProtecT randomized controlled trial (including men with low risk and favorable intermediate-risk disease on AS versus treatment) had previously found a non-significant 1.7-fold increase in PCSM for AS vs RP at 10 years.

Survival estimates for PCSM were 99.86%, 99.01%, and 97.63% at 5, 10, and 15 years for 920 favorable-risk patients who underwent RP at 8 Veterans Affairs hospitals during 1988 to 2017. If the risk of PCSM on AS were 1.5 times greater than the risk on RP, the researchers estimated that 92 patients would need to be put on AS for 1 excess death to occur over 15 years (a 1.09% excess PCSM risk). On the other extreme, if PCSM risk on AS were 5 times higher, 12 patients would need to be put on AS for 1 excess death over 15 years (an 8.68% excess PCSM risk).

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These estimated excess risks of PCSM after AS were relatively low, according to Dr Kuhlmann’s team, suggesting AS may be a safe alternative to RP in favorable intermediate-risk patients. Prospective randomized trials are needed to validate these findings.

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Kuhlmann PK, Oyekunle T, Howard LE, et al. Predicted risk of prostate cancer-specific mortality on active surveillance for men with favorable intermediate-risk prostate cancer: Results from the Search Database. Presented at the American Urological Association 2020 Virtual Experience, May 15-19, 2020. Abstract PD62-08.