EAU 2017: Metastases and death after 15 year of follow-up in men with screen-detected low-risk prostate cancer treated with protocol based active surveillance, radical prostatectomy or radiotherapy

London, England (UroToday.com) At this afternoon’s EAU 2017 Active Surveillance for Low-Risk Prostate Cancer poster session, Dr. Roobol and colleagues from The Netherlands presented their research on 15-year follow-up for men receiving active surveillance (AS), radical prostatectomy (RP), or radiotherapy (RT), specifically assessing metastases and death outcomes. With last year’s reporting of the ProtecT trial [1] showing no difference in prostate-cancer survival after 10 years of follow-up, this study aimed to assess these outcomes in a similar cohort of men with longer follow-up.

The authors utilized the ERSPC Rotterdam (1993-2003) cohort to identify men diagnosed with prostate cancer at the first and second screening round and considered suitable for AS (n=223). These men were then compared to those undergoing RP (n=365) or RT (n=312). After a 15-year median follow-up, 18 men (2% overall) died from prostate cancer. There was no difference in prostate-cancer specific survival among men undergoing AS (97%; 95%CI 94.7-99.7), RP (98.5%; 95%CI 97.2-99.8) or RT (97.5%; 95%CI 95.5-99.5) (p=0.36). Similarly, there was no difference among the groups for metastasis-free survival (AS – 96.9%, 95%CI 94.4-99.4; RP – 97.9%, 95%CI 96.3-99.5; RT – 96.6%, 95%CI 94.4-99.0) (p=0.42). This study was comparable to ProtecT regarding no difference in mortality outcomes, however ProtecT showed worse metastasis outcomes for patients in the active monitoring group, contrary to the current study. This discrepancy can likely be explained by the randomization of a number of higher risk patients in ProtecT to active monitoring whereas this study appropriately selected patients for AS.

In summary, this study suggests that appropriately selected men for AS have no difference in metastasis free survival compared to men undergoing RP or RT. As the authors highlight, the AS protocol used herein (PRIAS protocol) is substantially different than the active monitoring arm utilized in the ProtecT trial. Men considering AS should be appropriately counselled about the risks and benefits, and these long-term mortality and metastases outcomes may assist with these discussions.

1. Hamdy FC, Donovan JL, Lane JA, et al. 10-Year Outcomes after Monitoring, Surgery or Radiotherapy for Localized Prostate Cancer. N Engl J Med 2016;375(15):1415-1424.

Speaker(s): Monique J. Roobol, Department of Urology, Erasmus MC, Rotterdam, The Netherlands

Co-Authors: F. Giganti, A. Kirkham, C. Allen, S. Punwani, M. Emberton, C. Moore

Written By: Zachary Klaassen, MD, Urologic Oncology Fellow, University of Toronto
Twitter: @zklaassen_md

at the #EAU17 - March 24-28, 2017- London, England

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