Younger patients with prostate cancer who have a lower risk of Gleason score upgrading and biopsy progression may also be good candidates for active surveillance (AS), according to a study published in Urology.1
AS is commonly used among patients with low-risk prostate cancer, as it may prevent adverse events (eg, erectile dysfunction, urinary incontinence) caused by definitive therapies, but despite strict eligibility criteria, has been associated with higher rates of histological progression. AS use among in younger patients remains controversial; the effect of age on outcomes in AS is not well reported and requires further study.
For this systematic review, the authors evaluated the outcomes of 8 studies encompassing 6544 patients with prostate cancer on AS. Because prior studies have varying primary outcomes, the authors performed subgroup analyses using biopsy progression (Gleason score upgrading and/or tumor volume increases at follow-up) or Gleason score upgrading as study outcomes. The estimated median age was 65.8 years.
Results showed that patients have a 13% to 17% lower risk of Gleason score upgrading per decade of decreasing age (odds ratio [OR], 0.83; 95% CI, 0.73-0.94; P = .004 and hazard ratio [HR], 0.87; 95% CI, 0.82-0.92; P < .0001). An analysis of pathological biopsy progression showed that patients also have a 12% to 20% lower risk of pathological biopsy progression (OR per decade decrease in age, 0.80; 95% CI 0.74-0.86; P < 0.0001 and HR, 0.88; 95% CI 0.79-0.99; P = 0.04).
For example, a 50-year old patient with prostate cancer on AS has a 24% to 40% lower risk of biopsy progression, and a 26% to 34% lower risk of Gleason score upgrading compared with a 70-year old patient.
The authors concluded that “in order to avoid interventional-related adverse events and to enhance quality of life, AS may be considered for younger patients. Further randomized control trials are warranted to compare the safety of AS versus other definitive treatments in young patients who are eligible for AS.”
- Mahran A, Turk A, Buzzy C, et al. Younger men with prostate cancer have lower risk of upgrading while on active surveillance: a meta-analysis and systematic review of the literature [published online July 26, 2018]. Urology. doi: 10.1016/j.urology.2018.06.048