Active surveillance (AS) is a reasonable option for carefully selected men with favorable intermediate-risk prostate cancer (PCa), investigators reported at the 20th annual meeting of Society of Urological Oncology in Washington, DC.
Men in this group do not differ significantly from men with very-low-risk PCa and low-risk PCa on AS in the risk of biochemical recurrence, metastasis, and progression to treatment, Andrew Gusev, MD, and colleagues at Massachusetts General Hospital in Boston concluded.
The 10-year rates of biochemical recurrence-free (BCR) survival for men with very-low-risk PCa, low-risk PCa, and favorable intermediate-risk PCa were 97.9%, 96.9%, and 94.5%, respectively. The 10-year rates of freedom from metastasis were 98.2%, 95.4%, and 91.3%, respectively. The 10-year rates of freedom from treatment were 56.9%, 55.1%, and 53.7%, respectively.
The study included 637 patients with very-low-risk PCa, 493 with low-risk PCa, and 130 with favorable intermediate-risk PCa. The study population had a median follow-up time of 6.4 years. Of the total cohort, 1232 men (96.8%) had Grade Group (GG) 1 cancer, 39 (3.1%) had GG 2 cancer, and 1 had GG 3 cancer. In the favorable intermediate-risk group, 100 (76.9%) had GG1 cancer and a PSA level above 10 ng/mL, 28 (21.5%) had GG2, and 2 (1.5%) had cT2 disease.
The AS protocol included PSA tests and digital rectal examinations every 4 to 6 months for 3 years, then annually if stable. Mandatory confirmatory 12-core biopsies were performed at 12 to 18 months. Since 2014, confirmatory biopsies included the use of multiparametric magnetic resonance imaging (MRI) and MRI-fusion. Additional imaging and/or biopsies were done at the discretion of physician and patient.
Gusev A, Salari K, Nicaise E, et al. Outcomes of active surveillance for men with localized prostate cancer stratified by AUA risk groups. Presented at the 20th annual meeting of the Society of Urologic Oncology held December 4 to 6 in Washington, DC. Poster 100.