Trends of Active Surveillance Management in Men with Low- and Intermediate-Risk Prostate Cancer

Active surveillance (AS) is the standard of care for patients with low-risk prostate cancer (PCa), but recent studies have suggested that it may be a feasible and safe treatment plan for some patients with intermediate-risk disease. To investigate this recommendation, Brooke Namboodri Spratte from the School of Medicine of the University of North Carolina, and other researchers examined trends of AS use in patients with low- and intermediate-risk PCa.

Their report, presented at the Society of Urologic Oncology’s 22nd Annual Meeting, found that AS in men with intermediate-risk disease has significantly increased in recent years—particularly in men with Gleason 3+3 disease and prostate-specific antigen (PSA) score of 10 to 20. In fact, the study observed that the proportion of patients with intermediate-risk PCa undergoing AS is nearing that seen in patients with low-risk disease.

The study included 27,010 men with low-risk disease (defined as Gleason 3+3 with PSA <10) and 38,133 men with intermediate-risk disease (defined as Gleason 3+4 or PSA ≥10), with further subgroups of Gleason 3+3 with PSA 10-20, Gleason 3+4 with PSA <10, Gleason 3+4 with PSA 10-20, and Gleason 4+3 with any PSA. AS use was indicated via absence of claims for surgery, radiation, androgen deprivation therapy, or chemotherapy within 12 months of PCa diagnosis.

Investigators found that use of AS had significantly increased among all groups except men with Gleason 4+3, which remained steady. Specifically, they reported that rates of AS increased from 28.1% to 67.2% for Gleason 3+3 with PSA <10 (p < 0.0001), from 26.8% to 57.9% for Gleason 3+3 with PSA 10 to 20 (p < 0.0001), from 12.7% to 26.2% for Gleason 3+4 with PSA <10 (p < 0.0001), and from 15.7% to 24.5% for Gleason 3+4 with PSA 10 to 20 (p<0.0001).

The findings indicated the importance of Gleason score in selecting treatment, according to Spratte, although she added that “additional research is needed to define other determinants of active surveillance in this patient population.”