Younger men on prostate cancer (PCa) active surveillance (AS) are at lower risk of Gleason score upgrading and pathologic progression on repeat biopsy, according to a new study.
In a meta-analysis of 8 studies including 6522 patients with a median age of 65.8 years (range 41 to 86 years), Amr Mahran, MD, of University Hospitals Cleveland Medical Center in Cleveland, and colleagues found that each decade decrease in age was associated with an average 13% to 17% lower risk of Gleason score (GS) upgrading and 12% to 20% lower risk of pathologic biopsy progression, respectively.
Thus, a patient aged 50 years would be expected to have an average 13% to 17% lower risk of GS upgrading and 12% to 20% lower risk of biopsy progression compared with a patient aged 60 years, the authors reported online ahead of print in Urology. Compared with a patient aged 70 years, the 50-year-old man would be expected to have an average of 26% to 34% lower risk of GS upgrading and an average 24% to 40% lower risk of biopsy progression.
“Many urologists are skeptical to place younger patients on AS; however, younger patients may in fact have the most to benefit from AS,” the investigators commented.
Dr Mahran and his colleagues pointed out that younger patients are more likely to have a lower incidence of erectile and/or voiding dysfunction at the time of PCa diagnosis. “Immediate treatment may impose an increased risk of side effects such as incontinence and impotence,” they wrote. The investigators cited previous studies suggesting that the implications of active treatment also may result in treatment regret in addition to a lower quality of life.
“Contrary to many urologists’ practice, younger patients may be good candidates [for AS] if the strict criteria of AS were uniformly enforced,” the authors concluded.
The study, whose senior author was Lee E. Ponsky, MD, of University Hospitals Cleveland Medical Center, had as a major limitation the small number of studies that were included. The investigators noted that “this can be partially overcome with the large number of total subjects.”
Other limitations included inconsistencies in the definitions used for GS upgrading and biopsy progression.
Mahran A, Turk A, Buzzy C, et al. Younger men with prostate cancer have lower risk of upgrading while on active surveillance: Meta-analysis and systematic review of the literature.Urology. 2018; published online ahead of print.