NCCN Favorable Intermediate Risk Prostate Cancer Patients: Is Active Surveillance Appropriate?

To compare pathologic and biochemical outcomes after radical prostatectomy (RP) in favorable intermediate-risk patients who fulfilled current NCCN active surveillance (AS) criteria to outcomes in patients who met more traditional criteria for AS.

Our IRB-approved prostate cancer database was queried for patients meeting NCCN criteria for very low (T1c, Grade Group I, ≤3/12 cores, ≤50% core volume, and PSA density <0.15), low (T1-T2a, Grade Group 1, PSA <10), or favorable intermediate (major pattern grade 3, percentage of positive biopsy cores <50 %, and one intermediate risk factor [T2b/c, Grade Group II, or PSA 10-20]) risk. Intermediate risk patients not meeting favorable criteria were labeled as unfavorable intermediate risk. Favorable intermediate risk (FIR) patients were compared to lower risk (LR) (very low and low risk patients) and unfavorable intermediate risk (UIR patients) to identify differences in rates of adverse pathologic findings at RP (Gleason score Grade Group III-V, non-organ confined disease, or nodal involvement). The groups were compared on time to biochemical recurrence using Cox regression.

3686 patients underwent RP between 1/1/04 and 12/31/15; 1454, 250, and 1362 patients fulfilled criteria for LR, FIR and UIR groups, respectively. The rate of adverse pathological findings for FIR (27.4%) was significantly higher than for LR (14.8%)(p < 0.001) and significantly lower than for UIR (48.5%)( p < 0.001). Time to biochemical recurrence differed significantly over risk groups (p <.001).

Relative to LR, FIR patients represent a distinct group and care should be taken in selecting these patients for AS and in monitoring them once in AS programs.

The Journal of urology. 2017 Dec 26 [Epub ahead of print]

Monty A Aghazadeh, Jason Frankel, Matthew Belanger, Tara McLaughlin, Joseph Tortora, Ilene Staff, Joseph R Wagner

Urology Division, Hartford Healthcare Medical Group, Hartford Hospital, Hartford CT 06106, USA., Urology Division, Hartford Healthcare Medical Group, Hartford Hospital, Hartford CT 06106, USA. Electronic address: .