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 (804)

London, England (UroToday.com) Despite recent publicity regarding the results of the ProtecT trial, which demonstrated no difference in PCa-specific survival after a median of 10 yr follow-up (FU) between surgery (RP), radiotherapy (RT) and active monitoring (AM) in men with screen detected localized prostate cancer (PCa), the primary issue with the study remains that the active monitoring arm is significantly different than active surveillance. Inclusion of high-risk and intermediate-risk patients makes it difficult to translate the findings of the study to active surveillance (AS) literature. Specifically, the authors of this study attempt to address the issue of higher metastases in the AM arm by assessing the risk of metastases and death in screen-detected low-risk prostate cancer treated with protocol based active surveillance, radical prostatectomy or radiotherapy.

Using men identified with AS-suitable (GS ≤3+3, ≤T2a PCa) prostate cancer in the ERSPC Rotterdam cohort (1999-2003), they retrospectively reviewed the outcomes of men treated with AS according to the PRIAS protocol (n=223), having had a RP (N=365) or treated with RT (n=312).

Table 1 below demonstrates the basic demographics of the three arms. The AM arm is older, has lower initial PSAs, and more likely to be cT1c. The authors acknowledge the unbalanced groups.

chart 19

With a median follow-up of 15 years (IQR 12-17), they then assessed for cancer-specific survival and metastases-free survival. There were a total of 18 PCa-specific deaths.

Similar to ProtecT, no significant difference in PC specific survival was found between AS, RP and RT (log-rank p=0.36). However, contrary to ProtecT, M+-free survival was also similar amongst the three groups. Table 2 highlights these findings.

chart 19B

While the authors acknowledge that the groups are not evenly matched, they are likely representative of clinical practice. They help confirm what most already suspected from the ProtecT study results.

Speaker(s): J. Verbeek

Co-Authors: Drost F-J., Bangma C., Roobol M.

Institution(s): Erasmus MC, Dept. of Urology, Rotterdam, The Netherlands

Written By: Thenappan Chandrasekar, MD, Clinical Fellow, University of Toronto
Twitter: @tchandra_uromd

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