Active surveillance (AS) is an approach for low and low-intermediate risk prostate cancer designed to reduce overtreatment. Despite close monitoring, a small subset of patients progress to metastatic disease.
We analyzed the clinical and pathological correlates on surveillance who eventually metastasized.
This was a single-centre, prospective cohort study. Eligible patients were managed with an expectant approach. The main outcome measure was metastasis free survival. Predictive factors for metastasis were identified.
Thirty of 980 patients developed metastasis. 211 of 980 patients were classified into intermediate risk, and fourteen of these progressed to metastatic disease. The median follow up was 6. 3 years. The median age and PSA was 70 years and 6. 2ng/ml. The median time to metastasis was 8. 9 years. Metastases occurred in bone in 18 patients (60%) and in lymph nodes in 13 (43%). PSA DT <3 years (HR 3. 7, 95%CI 1. 4-9. 4, p=0. 0006), GS 7 (HR 3. 0, 95%CI 1. 2-7. 3, p=0. 0018), and ≥3 total positive cores (HR 2. 7, 95%CI 1. 1-6. 8, p=0. 0028) were independent predictors for metastasis. Although the intermediate risk group had a higher risk for metastasis, those with GS6 and PSA >10 were not associated with increased risk of metastasis. Only 2 patients with GS 6 developed a metastasis; neither had surgical pathology grading.
AS appears safe for low and selected intermediate risk patients, particularly GS 6 with PSA > 10. Patients with elements of Gleason Pattern 4 on diagnostic biopsy are at increased risk for eventual metastasis when managed with an initial conservative approach.
The Journal of urology. 2015 Dec 17 [Epub ahead of print]
Toshihiro Yamamoto, Bindu Musunuru, Danny Vesprini, Liying Zhang, Gabriella Ghanem, Andrew Loblaw, Laurence Klotz
Division of Urology, Sunnybrook Health Sciences Centre, University of Toronto. , Department of Radiation Oncology, Sunnybrook Health Sciences Centre, University of Toronto. , Department of Radiation Oncology, Sunnybrook Health Sciences Centre, University of Toronto. , Division of Urology, Sunnybrook Health Sciences Centre, University of Toronto. , Department of Radiation Oncology, Sunnybrook Health Sciences Centre, University of Toronto. , Department of Radiation Oncology, Sunnybrook Health Sciences Centre, University of Toronto. , Division of Urology, Sunnybrook Health Sciences Centre, University of Toronto.