Brigham Hospital. US: Monitoring prostate cancer (PC) by active surveillance (AS), with the
expectation to initiate treatment if the cancer progresses, is a
preferred initial option for men with low-risk PC and a life expectancy
of at least 10 years. According to the results of a new study conducted
at Brigham and Women’s Hospital (BWH), there is evidence to also
support AS as an initial approach for men with favorable
intermediate-risk of PC (men with no evidence of the cancer spreading
beyond the prostate, a Gleason score of 3+4 or less and PSA,
prostate-specific antigen, under 20). These findings are published
online by JAMA Oncology.
“We
found that men with favorable intermediate-risk prostate cancer did not
have significantly increased risks of death compared to men with
low-risk prostate cancer,” said Ann Caroline Raldow, MD,
first author of the study and resident physician at BWH and the Harvard
Radiation Oncology Program. “The clinical significance of our findings
is that men with favorable intermediate-risk prostate cancer may also be
able to avoid, or at least defer the side effects of, prostate cancer
treatment, and enter an active surveillance program as an initial
approach.”
Researchers estimated and compared the risk of
PC-specific mortality (PCSM) and all-cause mortality (ACM) following
brachytherapy, a high dose radiation treatment, among men with low-risk
and favorable intermediate-risk PC in a prospective cohort study of
5,580 men (median age 68 years) at the Prostate Cancer Foundation of
Chicago between 1997 and 2013. Men with favorable intermediate-risk PC,
who had no more than half of all prostate biopsies containing PC, were
included in the study and were treated with prostate brachytherapy
alone.
The researchers found that men with favorable
intermediate-risk did not have significantly increased risk of PCSM and
ACM when compared to men with low-risk PC after a median follow up of
7.69 years. Additionally, the absolute estimates of PCSM were less than
one percent in men with low-risk and favorable intermediate-risk PC,
sugggesting that men with favorable intermediate-risk PC may also be
candidates for active surveillance.
To date, no direct comparison
has been made between favorable intermediate-risk and low-risk prostate
cancer with respect to PCSM or ACM following brachytherapy.
“While
awating the results of ProtecT, a randomized trial comparing active
surveillance with treatment, our findings provide evidence to support a
discussion of AS as an initial approach to men with favorable
intermediate-risk PC,” said Anthony Victor D’Amico, MD, PhD, senior
author of the study and chief, BWH Genitourinary Radiation Oncology.