Prostate cancer active surveillance is most appropriate for older men with low-risk disease, whereas younger men with intermediate-risk disease derive less benefit, investigators reported in JAMA Network Open.1
Eugenio Ventimiglia, MD, of IRCCS Ospedale San Raffaele in Milan, Italy, and colleagues created a state transition model using 1992-2014 data from the Prostate Cancer data Base Sweden involving 23,655 men with very low-risk to intermediate-risk prostate cancer. In this cohort, 6,177 men received active surveillance, and 7478 received watchful waiting.
The researchers simulated prostate cancer trajectories up to 30 years by age group at diagnosis, prostate cancer risk category, and Charlson Comorbidity Index.
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Younger men diagnosed at age 55 years who died of prostate cancer before age 85 had the highest prostate cancer death rates: 9%, 13%, and 15% among those with very low-, low-, and intermediate-risk disease, respectively. Older men diagnosed at age 70 years had lower prostate cancer death rates: 3%, 6%, and 7% among those with very low-, low-, and intermediate-risk disease, respectively,
The investigators also estimated patients’ remaining treatment-free life-years by age group and prostate cancer risk category. The mean proportion of remaining life-years without treatment for men diagnosed at age 55 years was 48%, 36%, and 29% for very low-, low-, and intermediate-risk prostate cancer, respectively. Men aged 70 years at diagnosis had higher mean proportions of remaining life-years without treatment: 77%, 66%, and 60% for those with very low-, low-, and intermediate-risk prostate cancer, respectively.
“The findings of this Swedish cohort study suggest that men older than 65 years with low-risk PC [prostate cancer] had a high proportion of treatment-free years (53%-70%) and a low risk of PC death (6%-8%), hence AS [active surveillance] was indicated among men in this subgroup,” Dr Ventimiglia’s team wrote. “In contrast, in men younger than 65 years, AS appeared to be indicated only in those with very low-risk PC.”
In an accompanying editorial, Ahmed O. Elmehrath, MD, of Cairo University in Egypt, commented, “These results may be useful in informing clinical practice with regard to disease management and follow-up of men with PC regarding the optimal selection of treatment strategies and their allocation to patient populations that will benefit most from their implementation.”2
References
- Ventimiglia E, Bill-Axelson A, Bratt O, et al. Long-term outcomes among men undergoing active surveillance for prostate cancer in Sweden. JAMA Netw Open. Published online September 14, 2022. doi:10.1001/jamanetworkopen.2022.31015
2. Elmehrath AO. Exploring the long-term outcomes of active surveillance among men with prostate cancer—Best for whom? JAMA Netw Open. Published online September 14, 2022. doi:10.1001/jamanetworkopen.2022.31024
This article originally appeared on Renal and Urology News
