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. 2020 Feb 1;126(3):583-592.
doi: 10.1002/cncr.32557. Epub 2019 Oct 22.

Prostate cancer mortality and metastasis under different biopsy frequencies in North American active surveillance cohorts

Jane M Lange  1 , Aaron A Laviana  2 , David F Penson  3   4 , Daniel W Lin  5 , Anna Bill-Axelson  6 , Sigrid V Carlsson  7   8   9 , Lisa F Newcomb  10 , Bruce J Trock  11 , H Ballentine Carter  12 , Peter R Carroll  13 , Mathew R Cooperberg  14 , Janet E Cowan  15 , Laurence H Klotz  16 , Ruth B Etzioni  1   17
Affiliations

Prostate cancer mortality and metastasis under different biopsy frequencies in North American active surveillance cohorts

Jane M Lange et al. Cancer. .

Abstract

Background: Active surveillance (AS) is an accepted means of managing low-risk prostate cancer. Because of the rarity of downstream events, data from existing AS cohorts cannot yet address how differences in surveillance intensity affect metastasis and mortality. This study projected the comparative benefits of different AS schedules in men diagnosed with prostate cancer who had Gleason score (GS) ≤6 disease and risk profiles similar to those in North American AS cohorts.

Methods: Times of GS upgrading were simulated based on AS data from the University of Toronto, Johns Hopkins University, the University of California at San Francisco, and the Canary Pass Active Surveillance Cohort. Times to metastasis and prostate cancer death, informed by models from the Scandinavian Prostate Cancer Group 4 trial, were projected under biopsy surveillance schedules ranging from watchful waiting to annual biopsies. Outcomes included the risk of metastasis, the risk of death, remaining life-years (LYs), and quality-adjusted LYs.

Results: Compared with watchful waiting, AS biopsies reduced the risk of prostate cancer metastasis and prostate cancer death at 20 years by 1.4% to 3.3% and 1.0% to 2.4%, respectively; and 5-year biopsies reduced the risk of metastasis and prostate cancer death by 1.0% to 2.4% and 0.6% to 1.6%, respectively. There was little difference between annual and 5-year biopsy schedules in terms of LYs (range of differences, 0.04-0.16 LYs) and quality-adjusted LYs (range of differences, -0.02 to 0.09 quality-adjusted LYs).

Conclusions: Among men diagnosed with GS ≤6 prostate cancer, obtaining a biopsy every 3 or 4 years appears to be an acceptable alternative to more frequent biopsies. Reducing surveillance intensity for those who have a low risk of progression reduces the number of biopsies while preserving the benefit of more frequent schedules.

Keywords: Gleason score; active surveillance; biopsy; microsimulation; prostate cancer.

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Conflict of interest statement

Conflicts of Interest:

BJT reports grants from MDxHealth, personal fees from GenomeDx Biosciences, and grants and personal fees from Myriad Genetics outside the submitted work. MRC reports personal fees from Dendreon, Astellas, GenomeDx, Myriad Genetics, and MDxHealth outside the submitted work. JEC reports that she is a paid statistical peer reviewer for Journal of Urology and Urology. SVC has received a lecture honorarium and travel support from Astellas Pharma (unrelated to current study). Authors not named here have disclosed no conflicts of interest.

Figures

Figure 1.
Figure 1.
Health states
Figure 2.
Figure 2.
Median years until treatment, median delay of treatment after upgrade, and mean number of biopsies under perfect AS compliance.
Figure 3.
Figure 3.
Projected net cumulative probability of metastasis and death versus mean number of biopsies by cohort and schedule.
Figure 4.
Figure 4.
Projected mean remaining LYs and QALYs by schedule and cohort.
Figure 5.
Figure 5.
Tornado plots for one-way sensitivity analyses, comparing the difference in QALYs between annual and five year based on the range of utilities in the literature. The vertical line represents the Annual-five year QALY difference under the base values.
See this image and copyright information in PMC

Comment in

References

    1. Tosoian JJ, Carter HB, Lepor A. & Loeb S. Active surveillance for prostate cancer: contemporary state of practice. Nat. Rev. Urol. 116, 1477–1490 (2016). - PMC - PubMed
    1. Chen RC et al. Active surveillance for the management of localized prostate cancer (Cancer Care Ontario guideline): American society of clinical oncology clinical practice guideline endorsement. J. Clin. Oncol. 34, 2182–2190 (2016). - PubMed
    1. Briganti A. et al. Active Surveillance for Low-risk Prostate Cancer: The European Association of Urology Position in 2018. Eur. Urol. 74, 357–368 (2018). - PubMed
    1. Sanda M. et al. Clinically Localized Prostate Cancer: AUA/ASTRO/SUO Guideline. Part I: Risk Stratification, Shared Decision Making, and Care Options. J. Urol. 199, 683–690 (2018). - PubMed
    1. Mahal BA et al. Use of Active Surveillance or Watchful Waiting for Low-Risk Prostate Cancer and Management Trends Across Risk Groups in the United States, 2010–2015. JAMA E1–E3 (2019). - PMC - PubMed

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