Active surveillance (AS) may be a viable option for appropriately chosen men with localized prostate cancer (PCa) in the intermediate- and high-risk category, researchers confirm.
“AS should be part of a shared treatment decision in carefully selected men with PCa based on low volume of disease, age, and comorbid conditions given the current risk of localized therapy,” Andrew J. Stephenson, MD, and colleagues of the Glickman Urological and Kidney Institute at Cleveland Clinic, concluded in the Journal of Urology, published online ahead of print.
The investigators reported interim results over a median 50.5 months for 635 men with localized PCa managed with AS at an academic hospital during 2002 to 2015. At baseline, the majority of men had low risk and very low-risk PCa, whereas 117 (18.4%) had intermediate- or high-risk disease based on National Comprehensive Cancer Network criteria. Certain patients with intermediate- or high-risk disease were deemed eligible for AS because they typically had low volume Gleason 7 disease, limited life expectancy due to age (over 70 years), and comorbidities. In recent years, genomic testing or multiparametric magnetic resonance imaging confirmed their favorable status.
Overall survival rates were 98% and 94% and metastases-free survival rates were 99% and 98% at 5 and 10 years, respectively. No PCa-specific deaths were reported. Higher-risk patients did have higher mortality from any cause, likely attributable to aging and coexisting illnesses.
In addition, 61% of patients at 5 years and 49% at 10 years had no need for active treatment. The vast majority did not have AS failure, defined as metastases, biochemical recurrence after local therapy intended for cure, or death from PCa. AS failure rates were 2.8% and 9.4% at 5 and 10 years, respectively. Curative intervention was recommended when PCa grade or volume increased or the patient requested it. Nearly 10% of patients had biochemical recurrence after deferred treatment, with a 5-year progression-free probability of 92%.
These findings generally coincide with results from two 2015 cohort studies with longer follow up (J Clin Oncol. 2015;33:272-277 and J Clin Oncol. 2015;33:3379-3385).
The median follow-up of 50.5 months in the current study precludes accounting of any additional metastases or cancer-specific deaths and limits the accuracy of the 10-year survival estimates.
“In an era in which PCa screening is under scrutiny, these results affirm the clinical utility of AS for very low, low, and select intermediate and high risk men diagnosed with PCa,” Dr Stephenson and colleagues stated.
1. Nyame YA, Almassi N, Haywood SC, et al. Intermediate-Term Outcomes of Men with Very Low/Low and Intermediate/High Risk Prostate Cancer Managed by Active Surveillance. J Urol. doi: 10.1016/j.juro.2017.03.123 [Epub ahead of print]