The role of active surveillance for men with intermediate-risk prostate cancer

This study examined the role of active surveillance in the management of intermediate-risk prostate cancer. Researchers concluded that active surveillance is a safe management method for selected patients with favorable intermediate-risk disease. Men with more aggressive cancer cells may benefit from active treatment early on.

Due to advances in the early detection of prostate cancer, many prostate tumors currently being diagnosed are localized. Many men with low- to intermediate-risk prostate cancer may benefit from delaying treatment. Active surveillance (AS) refers to actively monitoring tumor growth without actually administering treatment. The main aim of AS is to reduce overtreatment while also preserving treatment opportunities in patients with disease progression.

The role of AS for men with intermediate-risk disease is still being investigated. Most definitions of intermediate-risk disease include a tumor stage of 2, a Gleason score of 7 (indicating more aggressive cancer cells) and PSA levels (prostate specific antigen; a protein elevated in the blood in prostate cancer) between 10 and 20 ng/ml.

The aim of this study was to compare outcomes of AS in men with low-risk and intermediate-risk prostate cancer.

945 men with prostate cancer were included in this study. 732 of these men had low-risk prostate cancer. 213 men had intermediate-risk disease. All men were managed with AS. Survival outcomes were compared over an average period of 6.5 to 6.7 years.

96% of men with low-risk disease and 91% of men with intermediate-risk disease were metastasis-free (free from cancer spread) at 10 years. At 15 years, 95% of men with low-risk disease and 82% of men with intermediate-risk disease were metastasis-free. Overall, the risk of metastasis was increased 3.14-fold for men with intermediate-risk disease.

94.1% of men with intermediate-risk disease and a Gleason score of 6 or less with PSA levels lower than 20 ng/ml were metastasis-free at 15 years. This was 83.6% for those with a Gleason score of 7 (lower level) and PSA levels lower than 20 ng/ml. This reduced to 63.2% for those with a Gleason score of 7 (upper level) and PSA levels lower than 20 ng/ml.

At 10 years, 98% of men with low-risk disease and 97% of men with intermediate-risk disease had not died from prostate cancer. At 15 years, this was 97% for men with low-risk disease and 89% for men with intermediate-risk disease. Overall, the risk of dying from prostate cancer was 3.74 times higher for men with intermediate-risk disease.

Men with intermediate-risk disease were also 42% more likely to require active treatment during the study period. AT 15 years, 58% of men with low-risk disease had not undergone any treatment. This was 48% for men with intermediate-risk disease.

Researchers concluded that active surveillance is a safe management for men with low-risk disease and selected patients with favorable intermediate-risk disease. Researchers advised that men with higher Gleason scores may benefit from active treatment early on.

Since the analysis was based on only 213 men with intermediate-risk prostate cancer, larger studies are needed to confirm these results.