Active Surveillance Safe and Effective for Low-Risk Prostate Cancer

A prospective multicenter cohort study revealed that protocol-directed active surveillance is safe and effective for avoiding overtreatment and preventing undertreatment in patients with low-risk prostate cancer. The study included 2155 patients with favorable-risk prostate cancer and no prior treatment from 2008 to 2022 with a median follow-up of 7.2 years. The median age was 63 years with 83% White, 7% Black, 90% diagnosed with grade group 1 cancer, and median prostate-specific antigen 5.2 ng/ml. Ten years after diagnosis, the incidence of biopsy grade reclassification and treatment were 43% and 49%, respectively. There were 425 and 396 patients treated after confirmatory or subsequent surveillance biopsies (median of 1.5 and 4.6 years after diagnosis, respectively) with the 5-year recurrence rates of 11% and 8%, respectively. Progression to metastatic cancer occurred in 21 patients and there were 3 prostate cancer–related deaths. The estimated rates of metastasis or prostate cancer–specific mortality at 10 years after diagnosis were 1.4% and 0.1%, respectively, with overall mortality of 5.1% in the same period. The results suggest that delayed treatment did not lead to worse outcomes vs treatment within the first 2 years of diagnosis, alleviating concern about losing a window of curability and adding to evidence for active surveillance in patients with favorable-risk prostate cancer. Source: https://jamanetwork.com/