Why men abandon active surveillance for prostate cancer

Categories: Spring 2022
7R35165
There’s new research on active surveillance, and there’s still more to learn. © Sanford Radom, MD

Dr. Catalona’s multi-institutional collaborative research team’s SPORE project results were highlighted in Prostate Cancer Advisor, Oct. 2021. The key results, first reported in The Journal of Urology, were that men with high-volume Gleason Grade Group 1 tumors behaved similarly to those with higher-risk prostate cancers.

Among 6775 men who initially chose prostate cancer active surveillance or watchful waiting at 28 community clinics in the US, Canada, the Netherlands, and Australia during 1991-2018, 2260 men (33.4%) converted to treatment over a median of 6.7 years.  The reasons for conversion to active treatment included higher tumor grade (48.8%), tumor volume progression (7.2%), and PSA progression (8.5%), inclusive of men with overlapping factors; another 5% of men converted to treatment due to anxiety alone.

Compared with men who had Gleason Grade Group (GG) 1 tumor, men with GG2 and GG3-5 had significantly (57% and 77%) higher risks for conversion.  Every 5ng/mL increment in serum PSA was associated with an 18% higher risk for conversion.  Compared with men having a clinical-stage T1 tumor, those with clinical-stage T2, T3, or T4 tumor had a significantly 1.6-and 4.4-fold increased likelihood of converting to treatment, respectively.  As the number of biopsy cores with cancer increased from 1 or 2 to 3, 4, or more, the risk of conversion to active treatment increased significantly by 1.6-fold and 3.3-fold, respectively.

“High-volume (³4 cores) GG1 patients converted to treatment sooner than their low-volume (£3 cores) and intermediate-risk tumor counterparts, but at a similar interval to patients with high-risk tumors,” Dr. Catalona’s team reported.  “This finding warrants future investigation regarding tumor biology and counseling of men with high-volume GG1 disease.”

Every 5-year increase in age was significantly associated with a 4% lower risk of conversion indicating that younger men commonly switched to treatment.  A more recent year of diagnosis also predicted conversion to treatment, possibly reflecting that, in recent years, more patients with the higher-risk disease are initially adopting active surveillance as their initial management, and then sooner converting to active treatment.

Self-reported race coupled with genetic ancestry data did not significantly predict quicker conversion.  Longer-term research is required to determine the best candidates and criteria for active surveillance.

Cooley LF, et al. J Urol. 2021; 206: 1147-1156.

Subscribe to Quest

"*" indicates required fields

Email

This email address is only for subscribing or unsubscribing to or from Quest. Dr. Catalona cannot respond to questions concerning your Personal Health Information (PHI) that could identify you as an individual. This is a "cyber-security measure" for your protection that will help prevent anyone from legally or illegally accessing your personal health information.

Delivery Method (How do you want to receive your Quest publication?)*
Address*