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. 2020 Jun;203(6):1117-1121.
doi: 10.1097/JU.0000000000000742. Epub 2020 Jan 7.

Risk of Metastasis in Men with Grade Group 2 Prostate Cancer Managed with Active Surveillance at a Tertiary Cancer Center

Sigrid Carlsson  1   2   3 , Nicole Benfante  1 , Ricardo Alvim  1 , Daniel D Sjoberg  2 , Andrew Vickers  2 , Victor E Reuter  4 , Samson W Fine  4 , Hebert Alberto Vargas  5 , Michal Wiseman  1 , Maha Mamoor  1 , Behfar Ehdaie  1 , Vincent Laudone  1 , Peter Scardino  1 , James Eastham  1 , Karim Touijer  1
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Risk of Metastasis in Men with Grade Group 2 Prostate Cancer Managed with Active Surveillance at a Tertiary Cancer Center

Sigrid Carlsson et al. J Urol. 2020 Jun.

Abstract

Purpose: We studied the risk of metastatic prostate cancer development in men with Grade Group 2 disease managed with active surveillance at Memorial Sloan Kettering Cancer Center.

Materials and methods: A total of 219 men with Grade Group 2 prostate cancer had disease managed with active surveillance between 2000 and 2017. Biopsy was performed every 2 to 3 years, or upon changes in magnetic resonance imaging, prostate specific antigen level or digital rectal examination. The primary outcome was development of distant metastasis. The Kaplan-Meier method was used to estimate treatment-free survival.

Results: Median age at diagnosis was 67 years (IQR 61-72), median prostate specific antigen was 5 ng/ml (IQR 4-7) and most patients (69%) had nonpalpable disease. During followup 64 men received treatment, including radical prostatectomy in 36 (56%), radiotherapy in 20 (31%), hormone therapy in 3 (5%) and focal therapy in 5 (8%). Of the 36 patients who underwent radical prostatectomy 32 (89%) had Grade Group 2 disease on pathology and 4 (11%) had Grade Group 3 disease. Treatment-free survival was 61% (95% CI 52-70) at 5 years and 49% (95% CI 37-60) at 10 years. Three men experienced biochemical recurrence, no men had distant metastasis and no men died of prostate cancer during the followup. Median followup was 3.1 years (IQR 1.9-4.9).

Conclusions: Active surveillance appears to be a safe initial management strategy in the short term for carefully selected and closely monitored men with Grade Group 2 prostate cancer treated at a tertiary cancer center. Definitive conclusions await further followup.

Keywords: neoplasm grading; prostatic neoplasms; watchful waiting.

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Treatment-free survival
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References

    1. Choo R, Klotz L, Danjoux C et al.: Feasibility study: watchful waiting for localized low to intermediate grade prostate carcinoma with selective delayed intervention based on prostate specific antigen, histological and/or clinical progression. J Urol, 167: 1664, 2002 - PubMed
    1. Tosoian JJ, Mamawala M, Epstein JI et al.: Intermediate and Longer-Term Outcomes From a Prospective Active-Surveillance Program for Favorable-Risk Prostate Cancer. J Clin Oncol, 33: 3379, 2015 - PMC - PubMed
    1. Klotz L, Vesprini D, Sethukavalan P et al.: Long-term follow-up of a large active surveillance cohort of patients with prostate cancer. J Clin Oncol, 33: 272, 2015 - PubMed
    1. Klotz L: Active surveillance for low-risk prostate cancer. Curr Opin Urol, 27: 225, 2017 - PubMed
    1. Bul M, Zhu X, Valdagni R et al.: Active surveillance for low-risk prostate cancer worldwide: the PRIAS study. Eur Urol, 63: 597, 2013 - PubMed

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