Surveillance a Good Option in Very Low-Risk Prostate Cancer

Men with low-risk prostate cancer monitored by active surveillance are not likely to have their disease spread to other organs or to die of their prostate cancer, according to results of a study published in the Journal of Clinical Oncology.

Men in the study, followed with active surveillance rather than curative treatment, were about 24 times more likely to die from a cause other than prostate cancer over a 15-year period.

The long-term results of the study suggest that men with non-aggressive disease should consider active surveillance-the careful monitoring of their disease by their clinician-over treatments that can cause adverse events.

H. Ballentine Carter, MD, professor of urologic oncology and director of adult urology at Johns Hopkins Medical Center in Baltimore, Maryland, and colleagues followed the outcomes of 1,298 men enrolled in the Johns Hopkins surveillance program over the past 20 years. Two of these men died of prostate cancer-including one who was in the active surveillance program for 16 years. An additional 3 men developed metastatic disease while 47 men died of causes other than prostate cancer, including cardiovascular disease. Nine men received treatment for their prostate cancer.

Patients in the study had 10-year cancer-specific survival, metastasis-free survival, and overall survival rates of 99.9%, 99.4%, and 93%, respectively. The 15-year rates were 99.9%, 99.4%, and 69%, respectively.

The median treatment-free survival was 8.5 years and ranged from 0.01 to 18 years.

“Our study should reassure men that carefully selected patients enrolled in active surveillance programs for their low-risk prostate cancers are not likely to be harmed by their disease,” said Carter in a statement. Still, Carter pointed out that the positive outcomes of the study may be due to the clinicians’ ability to select the right patients for active surveillance. “With longer follow-up, the data may change, but they’re unlikely to change dramatically, because men in this age group tend to die of other causes,” he added.

At 10 and 15 years, the cumulative incidence of reclassification of prostate cancer grade was 26% and 31%, respectively. Factors that contributed to reclassification included older age (hazard ratio [HR] of 1.03 for each additional year), prostate-specific antigen (PSA) density (HR, 1.21), and greater number of positive biopsy cores (HR of 1.47 for each additional positive core).

The men in the study had a median age of 66 years. Very low-risk prostate cancer criteria included clinical stage T1c disease, PSA density less than 0.15 ng/mL, biopsy Gleason score ≤ 6, two or fewer positive biopsy cores, and a maximum of 50% involvement of any biopsy core with cancer. Older men with low-risk disease defined as those with clinical stage of T2a or less were also included in the cohort.

The results of the study apply to Caucasian men as almost 85% of the men in the study were Caucasian; only 7.4% were African Americans.