AUA 2017: Active Surveillance for Low-Risk Prostate Cancer in Men Under 60 Years of Age
This was a retrospective study analyzing data from two AS institutional databases from the Massachusetts General Hospital (MGH) (n = 990) and Sunnybrook Health Sciences Centre in Toronto, Canada (n =1162). All men diagnosed with low-risk prostate cancer between 1990-2016 were included with a total of 432 men under the age of 60 (n = 181, MGH; n = 251, Sunnybrook). Clinical outcomes were analyzed, including repeat biopsy data, progression to treatment, and pathologic staging in those who were treated surgically. Survival analysis was performed as well.
At diagnosis, median age was 55 years (IQR 53-57) and median PSA was 4.6 ng/mL (IQR 3.1-5.9), with only 11/432 men having a PSA ≥10 ng/mL. The vast majority of patients had Gleason ≤6 (97.7%) and clinical stage T1 (91.9%) disease. Median follow-up was 5.1 years (IQR: 3.1-8.4), and > 84% (364/432) had a repeat biopsy with >62% (228/364) demonstrating prostate cancer, 24.5% (89/364) with no signs of disease, 7.7% (28/364) showing only PIN, and 5.2% (10/364) with atypia. Kaplan-Meier actuarial freedom-from-treatment was 74.3% at 5 years and 55.4% at 10 years. Of all 432 patients, 131 (30.3%) required treatment for the following reasons: pathologic progression (64.1%), PSA progression (18.3%), patient preference (11.5%), volume progression (3.1%) and other reasons (3.1%). Of the 131 treated patients, 62.6% underwent radical prostatectomy, 13.0% underwent high-intensity focal ultrasound therapy, 12.2% underwent external beam radiation and 10.7% had brachytherapy.
Postoperative pathology of the patients undergoing radical prostatectomy demonstrated that 88.2% (60/68) of patients had pT2, and 11.8% (8/68) had pT3 disease. Five patients developed metastasis (2 with positive lymph nodes at time of radical prostatectomy, and 3 with distant metastasis). Metastasis-free survival was 99.7% and 97.5% at 5 and 10 years, respectively. During the entire follow-up period, no prostate-cancer specific deaths had occurred.
To conclude, Dr. Salari stated that AS is a reasonable option for carefully selected men under 60 with low-risk prostate cancer. However, close surveillance is mandatory and patients must understand the significant existing risk of ultimately requiring treatment.
Presented By: Keyan Salari, Boston, MA
Written By: Hanan Goldberg, MD, Urologic Oncology Fellow (SUO), University of Toronto, Princess Margaret Cancer Centre
at the 2017 AUA Annual Meeting - May 12 - 16, 2017 – Boston, Massachusetts, USA