Long-term PCa surveillance data point to favorable outcomes

A new study underscores the long-term value of active surveillance for men with low- or very low-risk prostate cancer.

The findings should help reassure urologists about offering active surveillance to patients, says one expert urologist.

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Researchers from Johns Hopkins University in Baltimore, who published their findings online in the Journal of Clinical Oncology (Aug. 31, 2015), studied survival statistics for up to 15 years in a group of 1,298 prostate cancer patients enrolled in an active surveillance program at the Johns Hopkins Hospital. They reported that two of the patients died of prostate cancer and three developed metastatic disease during the study.

Other findings: 47 of the men died of non-prostate cancer causes and nine of those 47 had been treated for prostate cancer. The authors calculated that men in the program were 24 times more likely to die from something other than prostate cancer during the 15-year period. After 10 and 15 years of follow-up, survival free of prostate cancer death was 99.9%, and survival without metastasis was 99.4%, according to a press release from Johns Hopkins.

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Thirty-six percent of the men studied had prostate cancers that were reclassified to a more aggressive level within an average of 2 years from enrollment in the active surveillance program. For men with very low-risk cancers, the cumulative risk of a grade reclassification to a level that would have usually precluded enrollment in the program was 13% in 5 years, 21% in 10 years, and 22% in 15 years. The risk went up for men with low-risk cancers to 19% in 5 years, 28% in 10 years, and 31% in 15 years.

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“Men with favorable-risk prostate cancer should be informed of the low likelihood of harm from their diagnosis and should be encouraged to consider surveillance rather than curative intervention,” the authors concluded.

In the case of this study, 109 men chose surgery or radiation even though their cancer status had not significantly changed.

“Our study should reassure men that carefully selected patients enrolled in active surveillance programs for their low-risk prostate cancers are not likely to be harmed by their disease,” said senior author H. Ballentine Carter, MD. “Our goal is to avoid treating men who don’t need surgery or radiation. The ability to identify men with the most indolent cancers for whom surveillance is safe is likely to improve with better imaging techniques and biomarkers.”

Limitations of the study include that most of the men in the group were Caucasian and these outcomes might not apply to African-American men, who tend to have more aggressive prostate cancer, according to Dr. Carter. The outcomes also could be impacted by the physicians’ careful patient selection for active surveillance, according to the Johns Hopkins press release.

Overall, however, the study’s findings are reassuring, according to J. Brantley Thrasher, MD, of the University of Kansas Medical Center, Kansas City, who was not involved with the study.

“This study does give us a better idea of the risk to men choosing [active surveillance], said Dr. Thrasher, a Urology Times editorial consultant. “I do think this helps all of us feel better about assigning [active surveillance] to men with low-risk and very low-risk prostate cancer. However, longer follow-up is needed to continue to justify this approach.”