Active surveillance (AS) is a management option for men diagnosed with low-risk prostate cancer. Opinions differ on whether it is safe to include young men (≤60 yr) or men with intermediate-risk disease.
To assess whether reasons for discontinuation, treatment choice after AS, and adverse pathology at radical prostatectomy (RP; N1, or ≥GG3, or ≥pT3) differ for men ≤60 yr or those with European Association of Urology (EAU) intermediate-risk disease from those for men >60 yr or those with EAU low-risk disease.
We analyzed data from 5411 men ≤60 yr and 14 959 men >60 yr, 14 064 men with low-risk cancer, and 2441 men with intermediate-risk cancer, originating from the GAP3 database (21 169 patients/27 cohorts worldwide).
Cumulative incidence curves were used to estimate the rates of AS discontinuation and treatment choice.
The probability of discontinuation of AS due to disease progression at 5 yr was similar for men aged ≤60 yr (22%) and those >60 yr (25%), as well as those of any age with low-risk disease (24%) versus those with intermediate-risk disease (24%). Men with intermediate-risk disease are more prone to discontinue AS without evidence of progression than men with low-risk disease (at 1/5 yr: 5.9%/14.2% vs 2.0%/8.8%). Adverse pathology at RP was observed in 32% of men ≤60 yr compared with 36% of men >60 yr (p = 0.029), and in 34% with low-risk disease compared with 40% with intermediate-risk disease (p = 0.048).
Our descriptive analysis of AS practices worldwide showed that the risk of progression during AS is similar across the age and risk groups studied. The proportion of adverse pathology was higher among men >60 yr than among men ≤60 yr. These results suggest that men ≤60 yr and those with EAU intermediate-risk disease should not be excluded from opting for AS as initial management.
Data from 27 international centers reflecting daily clinical practice suggest that younger men or men with intermediate-risk prostate cancer do not hold greater risk for disease progression during active surveillance.
European urology open science. 2022 Jun 14*** epublish ***
Sebastiaan Remmers, Jozien Helleman, Daan Nieboer, Bruce Trock, Matthew E Hyndman, Caroline M Moore, Vincent Gnanapragasam, Lui Shiong Lee, Oussama Elhage, Laurence Klotz, Peter Carroll, Tom Pickles, Anders Bjartell, Grégoire Robert, Mark Frydenberg, Mikio Sugimoto, Behfar Ehdaie, Todd M Morgan, Jose Rubio-Briones, Axel Semjonow, Chris H Bangma, Monique J Roobol, Movember Foundation's Global Action Plan Prostate Cancer Active Surveillance (GAP3) Consortium
Department of Urology, Erasmus MC Cancer Institute, University Medical Center, Rotterdam, The Netherlands., The James Buchanan Brady Urological Institute, Johns Hopkins University, Baltimore, MD, USA., Southern Alberta Institute of Urology, University of Calgary, Calgary, AB, Canada., University College London, London, UK., Cambridge University Hospitals NHS Trust, Cambridge, UK., Singapore General Hospital, Singapore, Singapore., King's College London, London, UK., Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada., University of California San Francisco, San Francisco, CA, USA., University of British Columbia, BC Cancer Agency, Vancouver, BC, Canada., Skåne University Hospital, Malmö, Sweden., Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France., Monash University and Epworth HealthCare, Melbourne, Australia., Faculty of Medicine, Kagawa University, Kagawa, Japan., Memorial Sloan Kettering Cancer Center, New York, NY, USA., University of Michigan, Ann Arbor, MI, USA., Instituto Valenciano de Oncología, Valencia, Spain., University Hospital Muenster, Muenster, Germany.