Risk factors for disease reclassification in prostate cancer patients on active surveillance

The authors determined the risk factors that led to disease reclassification (change in grade/status of the disease) in prostate cancer patients under active surveillance.

Active surveillance is common in early-stage prostate cancer management. It involves active monitoring of patients for any changes in symptoms or signs of disease progression. Thus, active surveillance provides an alternative to immediate treatment. Increase in prostate specific antigen (PSA – protein elevated in the blood when prostate cancer is present) is a common risk factor associated with change in the disease status in prostate cancer. A high PSA density occurs when a small part of the prostate is making a lot of PSA. 

The authors aimed to determine the risk factors that led to change in the disease status in prostate cancer patients undergoing active surveillance.

 810 patients were analyzed in this study with an average of 60 months follow-up.

The 5-year overall survival (patients who were still alive following the treatment) was 98%. The 5-year treatment-free survival (patients who did not require treatment on active surveillance) was 60%. The 5-year biopsy reclassification- free survival (disease status remained the same after tissue samples were taken and analyzed for cancer [biopsy]) was 40%. The average time from active surveillance until the treatment was received, was 25 months. The average time to disease reclassification was 17 months.

The number of biopsies and high PSA density were identified as independent risk factors. Patients who had increasing PSA density had a 59% increased risk of needing active treatment, specifically in men with smaller prostates. Patients with high PSA density had a 90% increased risk of undergoing biopsy reclassification. Patients who had more number of biopsies and patients who had less time in between the biopsies had a decreased risk of needing treatment and biopsy reclassification.

The authors concluded that PSA density was independently associated with biopsy reclassification and treatment in prostate cancer patients on active surveillance.