Investig Clin Urol.  2021 Jul;62(4):416-422. 10.4111/icu.20200601.

Active surveillance in males with low- to intermediate-risk localized prostate cancer: A modern prospective cohort study

• Rakauskas A
• Tawadros T
• Lucca I
• Herrera F
• Bourhis J
• Burruni R
• Gomes MN
• Codeluppi C
• Jolliet L
• Rosa SL
• Meuwly JY
• Jichlinski P
• Berthold D
• Valerio M

• KMID: 2516921
• DOI: http://doi.org/10.4111/icu.20200601

Abstract

Purpose
To compare the clinical outcome of males with low-risk and favorable intermediate-risk prostate cancer managed within a standardized modern protocol of active surveillance.
Materials and Methods
This was a prospective cohort study with strict and expanded active surveillance criteria in males with prostate cancer. Baseline assessment included multiparametric magnetic resonance imaging (mpMRI), extended systematic biopsy, and software-based MR-targeted biopsy. Follow-up included biannual prostate-specific antigen (PSA) check, mpMRI, and control biopsy once a year for the first 2 years, and afterward mpMRI every 2 years with additional tests as clinically indicated. The primary outcome was the transition rate to active treatment.
Results
A total of 51 patients were included: 17 (33%) and 34 (67%) followed protocols of strict (study arm 1) and expanded (study arm 2) active surveillance criteria, respectively. Median age and PSA were 65 years (IQR, 60–69 years) and 5.3 ng/mL (IQR, 4.5–7.7 ng/mL), respectively. At baseline, a median of 2 (IQR, 1–3) cores were positive out of 13 (IQR, 12–14) cores; 22 males (43%) had visible mpMRI lesions. Eight males (24%) in study arm 2 had Gleason score 3+4. After a median follow-up of 36 months (IQR, 24–48 mo), no patient in study arm 1 compared with 17 patients (33%) in arm 2 underwent active treatment (p<0.0005).
Conclusions
Although expanding eligibility criteria leads to a greater transition rate to active treatment, active surveillance should be contemplated in well-selected males with favorable intermediate-risk prostate cancer as the curability window seems to be maintained.

Keyword

Active surveillance; Magnetic resonance imaging; Prostate cancer