Long-term Follow-up Shows Feasibility of Active Surveillance in Low-Risk Prostate Cancer

1 Background: Active surveillance (AS) is an accepted management strategy for localized prostate cancer. However, the rate of pathological upgrading has not been well described in mature study cohorts. Furthermore, concern exists over the possibility of prostate cancer dedifferentiation with time in patients on AS. Methods: Patients in our prospectively collected AS database with at least one repeat prostate biopsy were included. Linear regression analysis was used to estimate the proportion of patients upgraded (Gleason 6 to 3+4 or higher, Gleason 3+4 to 4+3 or higher) with time from diagnostic biopsy. Results: 593 of 862 patients in our cohort had at least one repeat biopsy. Median follow-up was 6.4 years (max. 20.2 years). The total number of biopsies ranged from 2 to 6. 20% of patients were intermediate risk, 0.3 % high risk, all others low risk. 31.2% of patients were upgraded during active surveillance. The proportion of patients upgraded increased with time, suggesting prostate cancer dedifferentiation occurred at a rate of 1.0%/year (95%CI -0.12 to 2.16%/year). The estimated rate of increase was 2.5 times higher in patients with intermediate risk disease at diagnosis (rate 1.9%/year, 95%CI -0.7-4.6) compared with those with low risk disease (rate 0.75%/year, 95%CI -0.5-2.0). Further analysis is underway. 62% of upgraded patients (n=114) went on to have active treatment. Patients who were upgraded and treated had significantly greater PSA velocities (median 1.2 ng/ml/y vs 0.42 ng/ml/y, p=0.01) and significantly higher Gleason scores when upgraded, than those who remained on surveillance (21.8% vs 2.8% Gleason 8-10, p<0.01). Conclusions: This is the largest re-biopsy cohort, with long-term follow-up, described to date, enabling the first estimates of prostate cancer dedifferentiation in patients on AS. Dedifferentiation rates appear higher in patients with intermediate risk prostate cancer compared with those who are low risk at baseline.

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Long-term oncological outcomes following active surveillance of low risk prostate cancer: A population-based study

European Urology Open Science ◽

10.1016/s2666-1683(20)33884-2 ◽

2020 ◽

Vol 19 ◽

pp. e1907

Author(s):

N. Timilshina ◽

A. Finelli ◽

P. Richard ◽

M. Komisarenko ◽

L. Martin ◽

...

Keyword(s):

Prostate Cancer ◽

Active Surveillance ◽

Population Based ◽

Low Risk ◽

Population Based Study ◽

Oncological Outcomes ◽

Risk Prostate Cancer ◽

Low Risk Prostate Cancer

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First repeated biopsy represents the most informative predictor of progression-free survival at 3 years follow-up in patients included in an active surveillance protocol for low-risk prostate cancer

European Urology Supplements ◽

10.1016/s1569-9056(17)30815-1 ◽

2017 ◽

Vol 16 (3) ◽

pp. e1319

Author(s):

S. Luzzago ◽

N. Suardi ◽

P. Dell’Oglio ◽

N. Fossati ◽

U. Capitanio ◽

...

Keyword(s):

Prostate Cancer ◽

Active Surveillance ◽

Progression Free Survival ◽

Low Risk ◽

Free Survival ◽

Risk Prostate Cancer ◽

Low Risk Prostate Cancer ◽

Surveillance Protocol

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Perspectives of health care professionals on active surveillance for the management of prostate cancer.

Journal of Clinical Oncology ◽

10.1200/jco.2018.36.6_suppl.81 ◽

2018 ◽

Vol 36 (6_suppl) ◽

pp. 81-81

Author(s):

Fred Saad ◽

Kittie Pang ◽

Margaret Fitch ◽

Veronique Ouellet ◽

Simone Chevalier ◽

...

Keyword(s):

Prostate Cancer ◽

Health Care ◽

Active Surveillance ◽

Health Care Providers ◽

Low Risk ◽

Care Providers ◽

Radiation Oncologists ◽

Risk Prostate Cancer ◽

Low Risk Prostate Cancer

81 Background: Active surveillance has gained widespread acceptance as a safe approach for patients with low risk prostate cancer. Despite presenting several advantages for both patients and the health care system, active surveillance is not adopted by all eligible patients. In this study, we evaluated the factors that influence physicians to recommend active surveillance and the barriers that impact adherence to this approach. Methods: We conducted five focus groups with a total of 48 health care providers (HCP) including family physicians, urologists, surgeons, radiation oncologists, fellows, and residents/medical students. These participants were all providing care for men with low risk prostate cancer and had engaged in conversations with men and their families about active surveillance. The experience of these HCP from academic hospitals in four Canadian provinces was captured. A content and theme analysis was performed on the verbatim transcripts to understand HCP decisions in proposing active surveillance and reveal the facilitators that affect the adherence to this approach. Results: Participants agreed that active surveillance is a suitable approach for low risk prostate cancer patients, but expressed concerns on the rapidly evolving and non-standardized guidelines for patient follow-up. They raised the need for additional tools to appropriately identify the patients best suited for active surveillance. Collaborations between urologists, radiation-oncologists, and medical oncologists were favoured, however, the role of general practitioners remained controversial once patients were referred to a specialist. Conclusions: Integration of more reliable tools and/or markers, and more specific guidelines for patient follow-up would help both patients and physicians in the decision-making for active surveillance.

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