Active Surveillance of Favorable-Risk Prostate Cancer.

[Argirios Argiriou]

October 26, 2015

Robert Dreicer, MD, MS, FACP, FASCO reviewing Tosoian JJ et al. J Clin Oncol 2015 Oct 20. D'Amico AV. J Clin Oncol 2015 Oct 20.

Rates of overall survival, cancer-specific survival, and metastasis-free survival were 93.0%, 99.9%, and 99.4% at 10 years.

Active surveillance (AS) of prostate cancer is a structured, prospective management approach, in which men are monitored with serial prostate-specific antigen (PSA) testing, digital rectal examination (DRE), and prostate biopsies. It has been proposed as an effective approach for patients with favorable-risk disease, i.e., those at low risk for developing lethal metastasis. However, the data regarding patient prognosis has come only from institutional experiences.

Now, investigators report outcomes from a prospective AS program involving 1298 men over a 20-year period. Eligible patients had either very low risk (T1c, PSA density <0.15 ng/mL, Gleason score ≤6, ≤2 positive biopsy cores, and ≤50% of a core involved) or low-risk disease (≤T2a, PSA <10 ng/mL, and Gleason score ≤6). Patients underwent semiannual PSA assessment, DRE, and annual prostate biopsy with curative intervention advised at time of worsening disease parameters. The median follow-up was 5 years.

At time of data cut off, 642 men (50%) were actively being followed, 470 (36%) underwent curative intervention, and 186 (14%) were undecided regarding intervention, lost to follow-up, or deceased. Of the 49 deceased patients, 47 died as a result of causes other than prostate cancer. Rates of overall survival, cancer-specific survival, and metastasis-free survival (the primary outcomes) were 93.0%, 99.9%, and 99.4%, respectively, at 10 years, and 69.0%, 99.9%, and 99.4% at 15 years.

Given the long natural history of the disease, the authors acknowledge that follow-up in this institutional experience is incomplete, but feel that the current data support a more nuanced approach to the management of patients with favorable-risk prostate cancer.

Comment

Several limitations in this report were noted both by the authors and an editorialist, including the short median 5-year follow-up time and the limited ethnic diversity in this cohort (African-Americans represented only 7.4% of the study population). Data from a randomized study of AS versus intervention (Prostate Testing for Cancer and Treatment) may be available in the relative near term, providing the first evidence from a prospective, randomized trial of the utility of AS in favorable-risk disease. We also await validated predictive markers to more optimally select patients for AS.

Editor Disclosures at Time of Publication

Disclosures for Robert Dreicer, MD, MS, FACP, FASCO at time of publication Consultant / Advisory board Medivation; Genetech/Roche; Bind Pharmaceuticals; Astellas Editorial boards Urology; Clinical Genitourinary Cancer; Current Urology Reports Leadership positions in professional societies National Cancer Institute (Co-Chair, GU Oncology Steering Committee); American Board of Internal Medicine (member, Medical Oncology Test Writing Committee); Bladder Cancer Advocacy Network (member, scientific advisory board)

Citation(s):

Tosoian JJ et al. Intermediate and longer-term outcomes from a prospective active-surveillance program for favorable-risk prostate cancer. J Clin Oncol 2015 Oct 20; 33:3379. (Δεν είναι ορατοί οι σύνδεσμοι (links). Εγγραφή ή Είσοδος)

Abstract/FREE Full Text

D'Amico AV.Personalizing the use of active surveillance as an initial approach for men with newly diagnosed prostate cancer. J Clin Oncol 2015 Oct 20; 33:3365. (Δεν είναι ορατοί οι σύνδεσμοι (links). Εγγραφή ή Είσοδος)

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