Active surveillance on prostate cancer may reduce rate of mortality, metastases
Active surveillance on patients with localized prostate cancer results in a decreased rate of active surveillance failure, prostate cancer specific mortality and metastases regardless of baseline risk, according to a recent study.
Researchers compared intermediate term clinical outcomes in men (n=635) with favourable risk and intermediate/high-risk prostate cancer managed by active surveillance since 2002 at a high-volume academic hospital in the United States. Median follow-up was 50.5 months. Time-to-event analysis was conducted for the clinical endpoints.
Of the participants, 117 (18.4 percent) had intermediate/high-risk disease. In general, 98 and 94 percent had all-cause survival at 5 and 10 years, respectively. In addition, 5- and 10-year cumulative metastasis-free survival was 99 and 98 percent, respectively. There were no cancer-specific deaths recorded.
Overall 5- and 10-year freedom from intervention was 61 and 49 percent, respectively. Overall cumulative freedom from failure of active surveillance, defined as metastasis or biochemical failure after local therapy with curative intent, at 5 and 10 years was 97 and 91 percent, respectively.
Twenty-one (9.9 percent) men had biochemical failure after deferred treatment, and the progression-free probability at 5 years was 92 percent.
Patients with intermediate/high-risk cancer showed no difference in metastases, surveillance failure or curative intervention compared to those with favourable risk disease. However, men at higher risk had significantly elevated risk for all-cause mortality, likely reflecting patient selection factors.
These findings should be taken in light of certain limitations, including the small number of events and the duration of the study, according to researchers.