Four-Fold Higher Risk of Metastasesin Men on Active Surveillance with Gleason Pattern 4
The study included 980 men on active surveillance with a median follow-up of 6.3 years, although the single-center prospective study began in 1995. In the group, 30 patients (3.1%) developed metastasis. Men with any Gleason pattern 4 disease at baseline had a fourfold increased risk of progressing to metastatic disease. Independent predictors of metastatic disease were a PSA that doubled in less than 3 years, a Gleason score of 7, and three or more positive cores. Men with a Gleason score of 6 and PSA above 10 ng/ml did not have an increased risk of developing metastatic prostate cancer.
The authors noted that the cohort has “more mature” patients who have been followed for more than 15 years. This could explain in part the higher rate of metastasis in their cohort.
The study was published in the May 2016 issue of the Journal of Urology.
Research efforts to improve AS
An urgent focus in prostate cancer research is to better identify which patients are good candidates for active surveillance, and which patients need immediately treatment. Dr. Catalona’s research project with the Northwestern University SPORE (Specialized Project of Research Excellence), Impact of germline genetic variants on failure of active surveillance for prostate cancer, is looking for genetic markers associated with aggressive prostate cancer. Identifying these genetic markers, along with other risk factors such as family history and race/ethnicity, would help assess a man’s individualized risk for aggressive prostate cancer. A better understanding of these factors would help clinicians and patients make informed decisions about choosing active surveillance or immediate treatment. See pages 6-7 for more information on this project.