Active surveillance yields similar outcomes to prostate cancer treatment, 10-year data show

Long-term data recently published in JAMA indicate that active surveillance is an effective alternative to immediate surgery or radiation for patients with favorable-risk prostate cancer.¹

The 5-year incidence of recurrence was 11% among patients treated after the confirmatory biopsy and 8% among patients treated after the subsequent biopsies.

The data, collected as part of the Canary Prostate Active Surveillance Study (Canary PASS; NCT00756665), showed that at 10 years from diagnosis, 49% of men included in the study remained free of cancer progression or treatment. Further, only 2% of men developed metastatic disease, and less than 1% died due to the disease.

These outcomes compared favorably to patients who received upfront treatment. The authors noted,¹ “The rates of unfavorable outcomes, including adverse pathology at surgical procedure, recurrence after treatment, or metastasis, do not appear to be higher among patients who were treated after several years of surveillance compared to those treated immediately following the confirmatory biopsy.”

“The goal of active surveillance for prostate cancer is to reduce unnecessary treatments and side effects among those diagnosed with lower risk cancer while avoiding undertreatment of aggressive disease. We hope this study encourages a national acceptance of active surveillance as an effective management strategy for prostate cancer,” said principal investigator Daniel Lin, MD, in a news release on the findings.² Lin is a prostate cancer researcher and professor of urology at Fred Hutchinson Cancer Center and University of Washington Medicine in Seattle.

In total, 870 patients (40% of total cohort) in the study received treatment, with the majority undergoing prostatectomy or radiation. Of these, 425 were treated after the confirmatory biopsy at a median time to treatment of 1.5 years after diagnosis, and 396 underwent treatment after a subsequent surveillance biopsy at a median follow-up of 4.6 years after diagnosis.

The 5-year incidence of recurrence was 11% among patients treated after the confirmatory biopsy and 8% among patients treated after the subsequent biopsies.

Data also showed that the cumulative incidence of biopsy grade reclassification and treatment was 43% (95% CI, 40%-45%) and 49% (95% CI, 47%-52%), respectively, among the total cohort (n = 2155) at 10 years after diagnosis.

The 10-year incidence of developing metastasis was 1.4% in the total cohort (95% CI, 0.7%-2%). The estimated 10-year incidence of prostate-cancer specific mortality was 0.1% (95% CI, 0%-0.4%), and the incidence of overall mortality was 5.1% (95% CI, 3.8%-6.4%). In total 21 patients progressed to metastatic cancer, and there were 3 prostate cancer-related deaths.

Overall, Canary PASS trial was a multicenter, prospective, observational study that enrolled 2155 patients with localized prostate cancer. Patients were enrolled from 2008 to 2022 across 10 clinical trial sites in the United States. The median follow-up among all patients was 7.2 years, and the median age was 63.

Among the 2155 patients enrolled, 2008 received at least 1 surveillance biopsy, and about half (1003) of patients did not have any biopsy reclassification or treatment. Reclassification to a higher-grade cancer occurred early in surveillance in 374 patients and later during surveillance in 404 patients.

Of the 147 patients with no surveillance biopsy, 49 received treatment before biopsy.

Lisa Newcomb, PhD, a cancer prevention researcher at Fred Hutch, first author of the study, and a Canary PASS deputy director, concluded in the news release,² “This study should reassure people with prostate cancer that, with a lower risk cancer, they don’t need to receive treatment right away. By utilizing active surveillance, patients visit the clinic for regular exams and occasional biopsies and PSA tests, and many can avoid invasive treatments altogether.”

References

1. Newcomb LF, Schenk JM, Zheng Y, et al. Long-term outcomes in patients using protocol-directed active surveillance for prostate cancer. JAMA. 2024. doi:10.1001/jama.2024.6695

2. Active surveillance shown to be an effective management strategy for prostate cancer patients. News release. Fred Hutchinson Cancer Center. May 30, 2024. Accessed May 31, 2024. https://www.newswise.com/articles/active-surveillance-shown-to-be-an-effective-management-strategy-for-prostate-cancer-patients