Outcomes of Active Surveillance for Men With Intermediate-Risk Prostate Cancer

Abstract

A B S T R A C T PurposeActive surveillance (AS) is an option for the initial management of early-stage prostate cancer. Current risk stratification schema identify patients with low-risk disease who are presumed to be most suitable for AS. However, some men with higher risk disease also elect AS; outcomes for such men have not been widely reported. ; log-rank P ϭ .88). Among men undergoing surgery, none were node positive and none had biochemical recurrence within 3 years. Patients and Methods ConclusionSelected men with intermediate-risk features be appropriate candidates for AS, and are not necessarily more likely to progress. AS for these men may provide an opportunity to further reduce overtreatment of disease that is unlikely to progress to advanced cancer.

A 17-gene Assay to Predict Prostate Cancer Aggressiveness in the Context of Gleason Grade Heterogeneity, Tumor Multifocality, and Biopsy Undersampling

“…Finally, our validation study included men with biopsy Gleason 3 + 4 PCa, and in our primary analyses, we restricted our definition of high grade to primary Gleason pattern 4 or any pattern 5. The rationale for this decision was based on an explicit intention to include men whose tumors were expected to demonstrate a wider range of risk and an expectation that, given PCa epidemiology and policy trends, clinical entrance criteria for AS must eventually become broader [26,44]. Many Gleason pattern 3 + 4 tumors-especially those that are organ confined and/or those with a limited extent of pattern 4-may be marginally more aggressive, if at all, than Gleason 3 + 3 tumors.…”

Active Surveillance for Prostate Cancer: A Systematic Review of the Literature

“…5 [18]. Thirty-two percent of this cohort had Gleason 7 disease with higher % biopsy cores positive, median PSA was 10.3 ng/ml, and 38% were clinical stage T2.…”

“…Use of more stringent criteria for entry will limit the number of men offered surveillance, and it remains unknown whether the most ''conservative'' selection criteria are optimal. Although some series describe results of surveying men with Gleason 7 (3 + 4) tumors, most limit this approach to men with Gleason 6 tumors [9,[18][19][20]. Most centers do not have strict criteria with regard to patient age, and older men may opt for surveillance despite some higher-risk features, choosing to monitor their disease for early signs of progression when secondary local therapy can still be offered.…”

Active Surveillance of Prostate Cancer: Use, Outcomes, Imaging, and Diagnostic Tools

“…Although the safety of AS in higher-risk populations is not well established, the prognostic risk associated with Gleason score 3+4=7 cancer varies substantially between samples with 1% Gleason pattern 4 and 50% Gleason pattern 4. 97,98 Measuring such differences will enable better understanding of these risks, and, when clinically appropriate, consideration of careful expansion of AS to populations with minimal Gleason pattern 4 disease.…”