Active surveillance (AS) is an accepted means of managing low-risk prostate cancer. Because of the rarity of downstream events, data from existing AS cohorts cannot yet address how differences in surveillance intensity affect metastasis and mortality. This study projected the comparative benefits of different AS schedules in men diagnosed with prostate cancer who had Gleason score (GS) ≤6 disease and risk profiles similar to those in North American AS cohorts.
Times of GS upgrading were simulated based on AS data from the University of Toronto, Johns Hopkins University, the University of California at San Francisco, and the Canary Pass Active Surveillance Cohort. Times to metastasis and prostate cancer death, informed by models from the Scandinavian Prostate Cancer Group 4 trial, were projected under biopsy surveillance schedules ranging from watchful waiting to annual biopsies. Outcomes included the risk of metastasis, the risk of death, remaining life-years (LYs), and quality-adjusted LYs.
Compared with watchful waiting, AS biopsies reduced the risk of prostate cancer metastasis and prostate cancer death at 20 years by 1.4% to 3.3% and 1.0% to 2.4%, respectively; and 5-year biopsies reduced the risk of metastasis and prostate cancer death by 1.0% to 2.4% and 0.6% to 1.6%, respectively. There was little difference between annual and 5-year biopsy schedules in terms of LYs (range of differences, 0.04-0.16 LYs) and quality-adjusted LYs (range of differences, -0.02 to 0.09 quality-adjusted LYs).
Among men diagnosed with GS ≤6 prostate cancer, obtaining a biopsy every 3 or 4 years appears to be an acceptable alternative to more frequent biopsies. Reducing surveillance intensity for those who have a low risk of progression reduces the number of biopsies while preserving the benefit of more frequent schedules.
Cancer. 2019 Oct 22 [Epub ahead of print]
Jane M Lange, Aaron A Laviana, David F Penson, Daniel W Lin, Anna Bill-Axelson, Sigrid V Carlsson, Lisa F Newcomb, Bruce J Trock, H Ballentine Carter, Peter R Carroll, Mathew R Cooperberg, Janet E Cowan, Laurence H Klotz, Ruth B Etzioni
Department of Biostatistics, Fred Hutchinson Cancer Research Center, Seattle, Washington., Vanderbilt Center for Health Services Research, Vanderbilt University, Nashville, Tennessee., Department of Urologic Surgery, Vanderbilt University, Nashville, Tennessee., Department of Urology, University of Washington, Seattle, Washington., Department of Surgical Sciences, Uppsala University, Uppsala, Sweden., Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York., Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, Washington., Brady Urological Institute, Johns Hopkins University, Baltimore, Maryland., Department of Urology, Johns Hopkins Medicine, Baltimore, Maryland., Department of Urology, University of California at San Francisco, San Francisco, California., Department of Urology, Helen Diller Family Comprehensive Cancer Center, University of California at San Francisco, San Francisco, California., Mission Bay Library, University of California at San Francisco, San Francisco, California., Department of Urology, University of Toronto, Toronto, Ontario, Canada.