Phoenix, Arizona (UroToday.com) Carlsson actively provided the Memorial Sloan Kettering Cancer Center experience to long-term follow-up surveys. Although most patients with low-risk prostate cancer end their treatment, the active surveillance rate in the United States has greatly increased over the past few years to nearly 50% of low-risk patients. Interestingly, Swedish active surveillance rates are very high for low risk patients (~ 80%) and intermediate risk patients (~ 20%).
Many patients who are under active surveillance are trying to "take" or "cure" cancer. However, localized prostate cancer treatments generally result in a reduction in all functional areas and an increase in active surveillance is essential to reduce the overburden of treatment. What is still needed is an estimate of long-term oncological outcomes from a large-scale contemporary prospective population of active surveillance.
The Memorial Sloan Kettering Cancer Center is actively monitoring 2907 low-risk / intermediate-risk prostate cancer patients (2000-2017). In this cohort 92% of patients had Gleason 6 disease (grade 1). The majority of patients had untouchable disease (89%). The active surveillance protocol at Memorial Sloan Kettering Cancer Center includes PSA and digital rectal exam every 6 months, prostate MRI every 18 months and prostate biopsy every 36 months.
According to a long-term follow-up study, as shown in Figure 1, 25% of men who are actively monitored by Gleason 6 have a 5-year risk, 36% at 10 years and 41% at 15 years.
Figure 1: Long-term risk of upgrading in men with active surveillance:
The probability of maintaining active surveillance was high in the low-risk group (78% in 5 years, 64% in 10 years, 57% in 15 years). A total of 2/3 patients underwent radical prostatectomy. The main reason for switching to therapy was grade progression. The incidence of metastases in patients with low-risk prostate cancer managed with active surveillance (0% at 5 years, 1% at 10 years, 5% at 15 years) was very low. One in 2,664 low-risk patients under active surveillance died of prostate cancer. The overall survival rate of these patients was very high and was 99% at 5 years, 94% at 10 years, 78% at 15 years (as shown in Figure 2)
Figure 2 – Overall survival after 15 years in a long-term follow-up study:
This long-term experience at the Memorial Sloan Kettering Cancer Center confirms previous reports that active surveillance is an oncologically safe management strategy. However, it is important to keep in mind that a well-defined management strategy requires the selection of the appropriate patient to be performed at the tertiary cancer center.
Presenter: Sigrid Carlsson, MD, Ph.D., MPH, Memorial Sloan Kettering Cancer Center
Written by @ Goldberg Hanan at the 19th Annual Meeting of the Urological Oncology Society (SUO), University of Toronto at SUO (University of Toronto) November 28-30, 2018 Hanan Goldberg, MD, Arizona