Active surveillance in males with low- to intermediate-risk localized prostate cancer: A modern prospective cohort study.

To compare the clinical outcome of males with low-risk and favorable intermediate-risk prostate cancer managed within a standardized modern protocol of active surveillance.

This was a prospective cohort study with strict and expanded active surveillance criteria in males with prostate cancer. Baseline assessment included multiparametric magnetic resonance imaging (mpMRI), extended systematic biopsy, and software-based MR-targeted biopsy. Follow-up included biannual prostate-specific antigen (PSA) check, mpMRI, and control biopsy once a year for the first 2 years, and afterward mpMRI every 2 years with additional tests as clinically indicated. The primary outcome was the transition rate to active treatment.

A total of 51 patients were included: 17 (33%) and 34 (67%) followed protocols of strict (study arm 1) and expanded (study arm 2) active surveillance criteria, respectively. Median age and PSA were 65 years (IQR, 60-69 years) and 5.3 ng/mL (IQR, 4.5-7.7 ng/mL), respectively. At baseline, a median of 2 (IQR, 1-3) cores were positive out of 13 (IQR, 12-14) cores; 22 males (43%) had visible mpMRI lesions. Eight males (24%) in study arm 2 had Gleason score 3+4. After a median follow-up of 36 months (IQR, 24-48 mo), no patient in study arm 1 compared with 17 patients (33%) in arm 2 underwent active treatment (p<0.0005).

Although expanding eligibility criteria leads to a greater transition rate to active treatment, active surveillance should be contemplated in well-selected males with favorable intermediate-risk prostate cancer as the curability window seems to be maintained.

Investigative and clinical urology. 2021 Jul [Epub]

Arnas Rakauskas, Thomas Tawadros, Ilaria Lucca, Fernanda Herrera, Jean Bourhis, Rodolfo Burruni, Maria Natal Gomes, Caroline Codeluppi, Laura Jolliet, Stefano La Rosa, Jean Yves Meuwly, Patrice Jichlinski, Dominik Berthold, Massimo Valerio

Department of Urology, University Hospital CHUV, Lausanne, Switzerland. ., Department of Urology, University Hospital CHUV, Lausanne, Switzerland., Department of Radiotherapy, University Hospital CHUV, Lausanne, Switzerland., Institute of Pathology, University Hospital CHUV, Lausanne, Switzerland., Department of Radiology, University Hospital CHUV, Lausanne, Switzerland., Department of Oncology, University Hospital CHUV, Lausanne, Switzerland.

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