Active surveillance in low risk prostate cancer patients effective management option to immediate surgery or radiation: JAMA

Active surveillance has emerged as the preferred management strategy for low-grade prostate cancer, involving regular PSA exams and prostate biopsies to monitor disease progression. Despite this, only about 60% of eligible patients opt for surveillance due to fears of undertreatment and missing a window of curability. Current clinical guidelines offer limited direction on the optimal surveillance approach, necessitating further research.

The study analyzed data from the Canary Prostate Active Surveillance Study (PASS), a collaborative observational study involving 10 North American centers. Participants included 2,155 men with favorable-risk prostate cancer, enrolled from 2008 through 2022. The median age was 63, and the median follow-up period was 7.2 years. The primary endpoints were biopsy grade reclassification, treatment, metastasis, prostate cancer mortality, overall mortality, and recurrence after treatment. The key findings were as follows

• 50% of men remained free from progression or treatment at 10 years.

• 43% had biopsy grade reclassification.

• 49% underwent treatment for prostate cancer.

• 18% required treatment after confirmatory biopsy (median 1.5 years).

• 18% required treatment after subsequent biopsies (median 4.6 years).

• 5-year recurrence rate: 11% (early treatment), 8% (later treatment).

• 10-year metastasis rate: 1.4%.

• Prostate cancer-specific mortality at 10 years: 0.1%.

• Overall mortality at 10 years: 5.1%.

The study's findings support the safety and effectiveness of active surveillance for managing low-risk prostate cancer. High adherence to biopsy schedules likely contributed to the low rates of metastasis and recurrence. Notably, the Canary PASS cohort had an 88% adherence to first follow-up biopsies within 2 years of diagnosis and 97% within 5 years. These results align with the premise that regular monitoring during surveillance is a safe management strategy.

Active surveillance, involving regular PSA exams and prostate biopsies, is a safe and effective management strategy for favorable-risk prostate cancer. The study's findings suggest that delayed treatment does not lead to worse outcomes compared to earlier treatment, reinforcing the potential of active surveillance to become a widely accepted approach for managing low-risk prostate cancer.

Reference:

Newcomb, L. F., Schenk, J. M., Zheng, Y., Liu, M., Zhu, K., Brooks, J. D., Carroll, P. R., Dash, A., de la Calle, C. M., Ellis, W. J., Filson, C. P., Gleave, M. E., Liss, M. A., Martin, F., McKenney, J. K., Morgan, T. M., Tretiakova, M. S., Wagner, A. A., Nelson, P. S., & Lin, D. W. (2024). Long-term outcomes in patients using protocol-directed active surveillance for prostate cancer. JAMA: The Journal of the American Medical Association. https://doi.org/10.1001/jama.2024.6695