Active Surveillance Program Improves Intermediate/Longer-Term Outcomes in Favorable-Risk Prostate Cancer
As reported in the Journal of Clinical Oncology by Tosoian et al, a prospective active surveillance program resulted in good intermediate/longer-term outcomes in men with favorable-risk prostate cancer.
Study Details
The program included 1,298 men with very-low-risk or low-risk disease enrolled between 1995 and June 2014 at Johns Hopkins medical institutions. Patients had a median age of 66 years at enrollment, 88% were white, and 7% were African American. Curative intervention was recommended for disease reclassification to higher cancer grade or volume on prostate biopsy.
Survival and Intervention Rates
Median follow-up was 5 years (range = 0.01–18.00 years), with a total of 6,766 person-years of follow-up since 1995. Overall, cancer-specific, and metastasis-free survival rates were 93%, 99.9%, and 99.4% at 10 years and 69%, 99.9%, and 99.4% at 15 years. The cumulative incidence of grade reclassification was 26% at 10 years and 31% at 15 years, and the cumulative incidence of curative intervention was 50% at 10 years and 57% at 15 years. Median treatment-free survival was 8.5 years (range = 0.01–18 years).
Factors Associated With Grade Change and Intervention
Factors associated with grade reclassification were older age (hazard ratio [HR] = 1.03 for each additional year, 95% confidence interval [CI] = 1.01–1.06), prostate-specific antigen (PSA) density (HR = 1.21 per 0.1-unit increase, 95% CI = 1.12–1.46), and greater number of positive biopsy cores (HR = 1.47 for each additional core, 95% CI = 1.26–1.69). Factors associated with intervention were PSA density (HR = 1.38 per 0.1-unit increase, 95% CI = 1.22–1.56) and greater number of positive biopsy cores (HR = 1.35 for each additional core, 95% CI = 1.19–1.53).
The investigators concluded: “Men with favorable-risk prostate cancer should be informed of the low likelihood of harm from their diagnosis and should be encouraged to consider surveillance rather than curative intervention.”
H. Ballentine Carter, MD, of Johns Hopkins Hospital, is the corresponding author of the Journal of Clinical Oncology article.
For full disclosures of the study authors, visit jco.ascopubs.org.
The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.
