Active Surveillance May Increase Likelihood of Adverse Outcomes in Low-Volume Intermediate-Risk Prostate Cancer

Active Surveillance May Increase Likelihood of Adverse Outcomes in Low-Volume Intermediate-Risk Prostate Cancer
Active surveillance may expose men with intermediate-risk prostate cancer to adverse outcomes that could be avoided by immediate intervention, according to the findings of a large cohort study. The study, “Adverse Pathologic Findings for Men Electing Immediate Radical Prostatectomy,” was published in the journal JAMA Oncology. Active surveillance is currently recommended to patients with very-low-risk (VLR) and low-risk (LR) prostate cancer. But more recent clinical guidelines have suggested that active surveillance also may be considered in men with low-volume intermediate-risk (LVIR) disease, a decision that remains controversial. In active surveillance, patients do not undergo immediate radical treatment, which includes surgery or radiation therapy. Instead, they are monitored carefully over time for signs of disease progression. Now, researchers at Johns Hopkins University School of Medicine performed a retrospective cohort study and compared the rate of signs of disease among VLR, LR, and LVIR men undergoing radical prostatectomy and evaluated retrospectively at Johns Hopkins Hospital. Specifically, researchers asked, “Is there a subset of men with Gleason 3+4=7 intermediate-risk prostate cancer with favorable characteristics to minimize risk of adverse pathologic findings at surgery?” In total, the study included 1,264 men with clinically localized VLR, 4,849 with LR, and 608 with LVIR, as defined by National Comprehensive Cancer Center (NCCN) criteria. Researchers found that the rate of adverse pathologic findings was significantly higher for LVIR disease when compared to those with LR or VLR disease, at 24.7%, 5.8%, and 4.7%, respectively. This means that men with LVIR had almost a 4.5-fold increase in the risk of adverse patho
Subscribe or to access all post and page content.