Active Surveillance for Early-Stage Prostate Cancer: Risk Factors for Metastases
Posted: Tuesday, March 16, 2021
According to a study based on more than 1,000 men with clinically low-risk prostate cancer enrolled on active surveillance at the University of California, San Francisco (UCSF), there seemed to be a low risk of metastasis, with up to 1% experiencing cancer spread or death from prostate cancer. Peter R. Carroll, MD, MPH, of UCSF, and colleagues emphasized that active surveillance is a viable option for men with low-risk and carefully selected intermediate-risk prostate cancer, in an article in The Journal of Urology. However, their study findings revealed three risk factors of metastasis to consider in this patient population: Gleason grade, prostate-specific antigen (PSA) velocity, and multiparametric MRI.
“These characteristics should be taken into account when selecting, following, and counseling patients for active surveillance,” advised Dr. Carroll and colleagues in a Wolters Kluwer press release.
From 1990 to 2018, a total of 1,450 men with early-stage disease were managed via active surveillance at UCSF. The median age of the men was 62 years. Although the average follow-up was about 6.5 years, some men (about 25%) were followed for 10 years or more.
The investigators reported that at 7 years, 1% of the men in their cohort developed metastatic disease, with less than 1% dying of the disease. More specifically, the overall survival rate was 98% in men with Gleason grade 1 cancers and slower PSA velocity, compared with 87% in those with Gleason grade 2 cancers. The study findings suggested that patients with faster increases in PSA values tended to have a higher risk of metastases. In addition, men with a high likelihood of clinically significant cancer on multiparametric MRI also were considered to be a higher risk of metastases.
Disclosure: For full disclosure of the study authors, visit auajournals.org.
