Half of Patients With Low-Risk Prostate Cancer Switch From Active Surveillance to Treatment

Active surveillance, intended to avoid unnecessary treatment and the resulting adverse effects, typically involves regular prostate-specific antigen (PSA) screenings, prostate exams, imaging studies, and repeat biopsies to carefully monitor prostate cancer growth or progression without compromising long-term outcomes.

Almost half of individuals with low-risk prostate cancer managed with active surveillance later transition to treatment within a few years of diagnosis, according to a study published in The Journal of Urology. Active surveillance, intended to avoid unnecessary treatment and the resulting adverse effects, typically involves regular prostate-specific antigen (PSA) screenings, prostate exams, imaging studies, and repeat biopsies to carefully monitor prostate cancer growth or progression without compromising long-term outcomes.

“These population-based data show that while the number of patients initiating active surveillance has significantly increased over time, follow-up shows a relatively high rate of transitioning to other forms of treatment within five years,” said Antonio Finelli, MD, MSc, FRCSC, in a press release.

The investigators analyzed 8541 patients with low-grade prostate cancer who were initially managed using active surveillance. According to the study, 51% of patients diagnosed with low-risk prostate cancer were initially managed with active surveillance, with its use increasing from 38% of patients in 2008 to 69% in 2014. However, a median of 4 years following diagnosis, 51% of study participants had discontinued active surveillance and proceeded to definitive treatment including surgery, radiation, or hormone therapy.

Signs of tumor progression were the primary reason for the transition to definitive treatment. The average time to treatment was 16 months, which mostly reflects the early reclassification of patients, according to the investigators.

The transition to treatment was more likely for younger patients and those with certain higher-risk characteristics, such as elevated PSA levels and more positive biopsies. It was also more likely for patients with a greater number of accompanying medical conditions and those treated at academic medical centers or at hospitals treating a high volume of patients with prostate cancer, according to the investigators.

“Current practice may be improved by the development of quality indicators, targeted continuing education for physicians, and patient education with shared decision making at the onset of active surveillance,” Finelli said in the release.

REFERENCE

One-half of patients with low-risk prostate cancer switch from active surveillance to active treatment [news release]. EurekAlert; August 20, 2021. Accessed August 23, 2021. https://www.eurekalert.org/news-releases/926031