ORLANDO—New studies support the use of active surveillance (AS) for selected patients with localized, low-risk prostate tumors.
In a study of 262 men with low-risk prostate cancer, a team led by Scott E. Eggener, MD, assistant professor of surgery at the University of Chicago Medical Center, showed that active surveillance is a safe and durable option that is associated with a low risk of systemic progression. All men had low-risk tumors, defined as clinical stage T1-T2a, a biopsy Gleason sum of 6 or less, a PSA level of 10 ng/mL or less, and three or fewer positive biopsy cores at initial diagnosis.
To be included in the study, all men had to be age 75 years or younger, needed to have at least two biopsies prior to commencing AS, and not received active treatment for a minimum of six months after the second biopsy. The patients had a median age of 69 years.
After a median follow-up of 29 months, 43 patients eventually underwent primary therapy in the form of radical prostatectomy, radiation therapy, or androgen deprivation.
The one-, two-, and five-year actuarial probabilities of remaining on AS were 95%, 91%, and 75%, respectively, Dr. Eggener told colleagues here at the American Urological Association annual meeting. Patients with cancer detected on the second biopsy and a higher number of cancerous cores from the first and second biopsy combined were more likely to undergo primary therapy, he said. Age and PSA level at diagnosis, clinical stage, number of positive cores at initial diagnosis, and number of total biopsy core samples, and prostate volume did not predict outcome.
Of the 26 patients who underwent radical prostatectomy, 13 (50%) had a pathological Gleason sum of 7 or higher, 24 (92%) had organ-confined tumors, and one (4%) had lymph node involvement. One patient on AS had a PSA rise from 6 to 24 ng/mL over a six-month period and developed skeletal metastases.
Dr. Eggener noted that their findings are based on a relatively short follow-up period, but “active surveillance appears to be a safe and feasible management option for patients with very low risk prostate cancer. It certainly is not for every patient or every treating physician.”
AS is increasingly under-discussed with patients and underutilized, Dr. Eggener said, adding: “It should at least be on the table as one of the management options.”