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Active surveillance ‘reasonable’ for younger men with low-risk prostate cancer
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Active surveillance for low-risk prostate cancer may be a reasonable option among carefully selected men aged younger than 60 years, according to data presented at the American Urological Association’s Annual Meeting.
Although active surveillance is becoming a commonly used practice by clinicians for the management of low-risk prostate cancer, data on outcomes of active surveillance in younger men are limited.
Keyan Salari, MD, PhD, resident in urologic surgery at Massachusetts General Hospital, and colleagues reviewed active surveillance databases from Massachusetts General Hospital (n = 990) and Sunnybrook Health Sciences Centre (n = 1,162) to determine characteristics and outcomes of men who began surveillance when aged younger than 60 years.
The final analysis included 432 patients (median age at diagnosis, 55 years; interquartile range [IQR], 53-57).
The cohort had a median PSA of 4.6 ng/mL (IQR, 3.1-5.9); only 11 of 432 men had PSA greater than 10 ng/mL. A majority of patients had a Gleason score less than 6 (97.7%) and stage I disease (91.9%).
Over a median follow-up of 5.1 years (range, 0.05-21.7; IQR, 3.1-8.4), 364 patients underwent repeat biopsy (84.3%). Of these, 228 (62.6%) showed prostate cancer; 89 (24.5%) appeared benign, 28 (7.7%) had prostatic intraepithelial neoplasia and 10 (5.2%) showed atypia.
Researchers reported Kaplan-Meier actuarial freedom-from-treatment rates of 74.3% at 5 years and 55.4% at 10 years.
Thirty percent of patients progressed to treatment (n = 131) due to pathologic progression (64.1%), PSA progression (18.3%), patient preference (11.5%), volume progressions (3.1%) or other reasons (3.1%).
Treatments included radical prostatectomy (62.2%), intense focal ultrasound therapy (13%), external beam radiation (12.2%) and brachytherapy (10.7%). After surgery, pathologic review showed 88.2% (n = 60 of 68) had pT2 disease and 11.8% (n = 8 of 68) had pT3 disease.
A majority of patients achieved metastasis-free survival at 5 years (99.7%) and 10 years (97.5%).
No prostate cancer-related deaths occurred.
“Active surveillance is a reasonable option ... however, patients must be surveyed closely and understand the significant risk [for] ultimately needing treatment,” the researchers wrote.
Reference:
Salari K, et al. Abstract PD55-03. Presented at: American Urological Association Annual Meeting; May 12-16, 2017; Boston.
Disclosures: HemOnc Today could not confirm relevant financial disclosures at the time of publication.
Perspective
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Stacy Loeb, MD
The new American Urological Association prostate cancer guidelines state that active surveillance is the best available care option for very low–risk prostate cancer and the preferable option for most patients with low-risk localized disease. The use of active surveillance is growing rapidly around the world, including for younger men. Our group previously published nationwide data from Sweden showing for men in their 50s, 88% with very low–risk disease and 68% with low-risk disease in the entire country chose active surveillance in 2014.
This new study reaffirms that active surveillance is a safe option for younger men to consider, with a very low risk for developing metastatic disease among carefully selected patients with close follow-up. Although many will eventually need radical treatment, surveillance often delayed treatment for several years. In fact, more than half of the population were still on surveillance at 10 years.
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