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Active surveillance may be appropriate for favorable intermediate-risk prostate cancer
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Men with low-risk and favorable intermediate-risk prostate cancers demonstrated comparable risks for prostate cancer-specific and all-cause mortality 10 years after brachytherapy, according to prospective study results.
The findings suggest that men with favorable intermediate-risk prostate cancer may safely undergo active surveillance, researchers wrote.
Fred Saad
Ann C. Raldow, MD, of the Harvard Radiation Oncology Program at Brigham and Women’s Hospital, and colleagues evaluated data from 5,580 men who underwent brachytherapy for localized adenocarcinoma of the prostate between 1997 and 2013. The median age of the population was 67.5 years (interquartile range [IQR], 61.45-72.71).
Researchers used National Comprehensive Cancer Network criteria to classify patients as having low-risk (n = 3,972) or intermediate-risk (n = 1,608) disease. Based on previous study data, the intermediate-risk category was considered favorable because the men had a Gleason score of 3 + 4 or less and a percentage of positive biopsy cores less than 50%.
Men with intermediate-risk disease were older (median age, 68.84 vs. 66.89 years), had a higher median PSA level (8.98 ng/mL vs. 5.92 ng/mL) and were less likely to have a Gleason score of 6 (52.61% vs. 100%; P ˂ .001 for all) than those with low-risk disease.
Median follow-up was 7.69 years (IQR, 5.42-10.55). By this time, 605 of the men (10.84%) had died.
Results of multivariable analyses indicated men with favorable intermediate-risk prostate cancer did not experience significantly increased risks for prostate cancer-specific mortality (HR = 1.64; 95% CI, 0.76-3.53) or all-cause mortality (HR = 1.11; 95% CI, 0.88-1.39) compared with men with low-risk disease.
Point estimates adjusted for age and year of brachytherapy indicated men with low- or favorable intermediate-risk disease experienced comparable 8-year incidence of prostate cancer specific mortality (0.33% vs. 0.48%) and all-cause mortality (8.68% vs. 10.45%).
“Despite potential study limitations, we found that men with low-risk prostate cancer and favorable intermediate-risk prostate cancer have similar and very low estimates of prostate cancer-specific mortality and all-cause mortality during the first decade following brachytherapy,” Raldow and colleagues concluded. “While awaiting the results of ProtecT, the randomized trial of active surveillance vs. treatment, our results provide evidence to support active surveillance as an initial approach for men with favorable intermediate-risk prostate cancer.”
Despite these data, active surveillance should still be implemented with caution, Fred Saad, MD, of the department of surgery at the University of Montreal, wrote in an invited commentary.
“One of the most important findings is that favorable intermediate-risk cancers can be very well controlled with brachytherapy,” Saad wrote. “This is very worthwhile information. What about expanding the indications for active surveillance? Although I am a urologist who has been practicing active surveillance for most of my low-risk patients for many years, I suggest that we continue to be very cautious, and extremely selective, in offering active surveillance to patients with any features of intermediate-risk prostate cancer.” – by Alexandra Todak
Disclosure: The researchers report no relevant financial disclosures.
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