Active surveillance in males with low- to intermediate-risk localized prostate cancer: A modern prospective cohort study

Abstract

Purpose To compare the clinical outcome of males with low-risk and favorable intermediate-risk prostate cancer managed within a standardized modern protocol of active surveillance. Materials and Methods This was a prospective cohort study with strict and expanded active surveillance criteria in males with prostate cancer. Baseline assessment included multiparametric magnetic resonance imaging (mpMRI), extended systematic biopsy, and software-based MR-targeted biopsy. Follow-up included biannual prostate-specific antigen (PSA) check, mpMRI, and control biopsy once a year for the first 2 years, and afterward mpMRI every 2 years with additional tests as clinically indicated. The primary outcome was the transition rate to active treatment. Results A total of 51 patients were included: 17 (33%) and 34 (67%) followed protocols of strict (study arm 1) and expanded (study arm 2) active surveillance criteria, respectively. Median age and PSA were 65 years (IQR, 60–69 years) and 5.3 ng/mL (IQR, 4.5–7.7 ng/mL), respectively. At baseline, a median of 2 (IQR, 1–3) cores were positive out of 13 (IQR, 12–14) cores; 22 males (43%) had visible mpMRI lesions. Eight males (24%) in study arm 2 had Gleason score 3+4. After a median follow-up of 36 months (IQR, 24–48 mo), no patient in study arm 1 compared with 17 patients (33%) in arm 2 underwent active treatment (p<0.0005). Conclusions Although expanding eligibility criteria leads to a greater transition rate to active treatment, active surveillance should be contemplated in well-selected males with favorable intermediate-risk prostate cancer as the curability window seems to be maintained.

Active Surveillance for Intermediate-risk Prostate Cancer: A Systematic Review, Meta-analysis, and Metaregression

“…9) relative to LR patients. Among the studies (n = 4) that compared the risk of PCa death in LR and IR patients, there were no PCa-related deaths in either group [26][27][28]31]. Allcause deaths were assessed in two studies [28,31].…”

“…Among the studies (n = 4) that compared the risk of PCa death in LR and IR patients, there were no PCa-related deaths in either group [26][27][28]31]. Allcause deaths were assessed in two studies [28,31]. Rakauskas et al [31] recorded no deaths in their cohort, and Mukherjee et al [28] found a similar rate of all-cause death between LR (18/276) and IR (7/96) PCa patients with GG 2 (p = 0.8).…”

“…Allcause deaths were assessed in two studies [28,31]. Rakauskas et al [31] recorded no deaths in their cohort, and Mukherjee et al [28] found a similar rate of all-cause death between LR (18/276) and IR (7/96) PCa patients with GG 2 (p = 0.8).…”

Comparison of Outcomes of Active Surveillance in Intermediate-Risk Versus Low-Risk Localised Prostate Cancer Patients: A Systematic Review and Meta-Analysis

“…Of these, scrutinising against the selection criteria, 591 studies were excluded after reading the title or abstract, and 34 studies were excluded after full-text review. Ultimately, 25 studies were included in the systematic review [ 11 , 14 , 15 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 ].…”

“…With all studies included, the chance of definitive treatment was 24% higher for the intermediate group than the low-risk group. As there was a very large difference for one study [ 30 ], the analysis was repeated with this study omitted. The results were not greatly changed by the omission of this study.…”