Men who undergo active surveillance for prostate cancer have a very low rate – one percent or less – of spread of cancer (metastasis) or death, according to a study recently published in the Journal of Urology®, an official journal of the American Urological Association from prostate cancer (AUA). The magazine is published by Wolters Kluwer in the Lippincott portfolio.
"Long-term, active surveillance is a safe and viable option for low-risk men with carefully selected intermediate-risk prostate cancer," said lead author Peter R. Carroll, MD, MPH, of the University of California, San Francisco (UCSF) ) and colleagues.
During active surveillance, prostate cancer is carefully monitored for signs of progression through regular prostate specific antigen (PSA) screening, prostate exams, imaging, and repeated biopsies. If symptoms occur or if tests suggest that the cancer is more aggressive, active treatment, such as surgery or radiation, may be needed.
New data on the results of active monitoring
The aim of active surveillance is to avoid or delay the side effects of treatment in men with favorable risk disease without affecting long-term outcomes such as survival or metastasis. Dr. Carroll and his team set out to evaluate the long-term outcomes of men in active surveillance for prostate cancer to determine what prognostic factors could predict the risk of metastasis.
The researchers analyzed 1,450 men with early-stage disease (mean age 62 years) who were treated under active surveillance at UCSF between 1990 and 2018. The mean follow-up was approximately 6.5 years; However, almost a quarter of the patients were followed up for 10 years or more.
The results showed that the risk of metastases during active long-term monitoring was influenced by three factors:
- Gleason Grade (GG), a standard measure of prostate cancer grade. At the first biopsy, 90 percent of men had low-grade prostate cancer (GG1) and 10 percent had moderate-grade cancer (GG2). In total, 99 percent of the patients lived without metastases after seven years. For those with GG2 cancer, that number was slightly but significantly lower: 96 percent.
- PSA speed or rate of change of this prostate cancer risk marker. Patients with faster PSA rise had a higher risk of metastasis.
- Multiparametric MRI. About half of the patients had a new imaging technique called multiparametric MRI. Men with a high probability of clinically significant cancer on multiparametric MRI had a higher risk of metastasis.
By age seven, one percent of the men in our cohort developed metastatic disease and less than one percent died of prostate cancer. "
Lead author Martina Maggi, MD, and co-authors
Overall survival rates varied depending on GG and PSA speeds: from 98 percent in men with GG1 cancer and slow PSA speeds to 87 percent in men with GG2 cancer.
The study provides new insight into the benefits of active surveillance with longer term follow-up than most previous reports. It also provides insight into risk factors for metastasis during follow-up: GG, PSA speed, and possibly multiparametric MRI. Dr. Maggi and colleagues conclude, "These characteristics should be considered in the selection, tracking and counseling of patients for active monitoring."
Lonergan, P.E., et al. (2020) Risk Factors for Temporal Reclassification of Biopsy in Men with Active Monitoring for Early Prostate Cancer. Journal of Urology. doi.org/10.1097/JU.0000000000001186.