Safety Concerns Over Active Surveillance for Intermediate-risk Prostate Cancer

Shared and informed decision making is the core in treatment of prostate cancer

If at any time a man is uncomfortable with active surveillance, he should express that concern as we can together agree on which treatment method is best for him

A recent cohort study from Harvard Medical School published in European Urology Focus found nearly one in three men with Gleason 3 + 4 favorable intermediate-risk (FIR) prostate cancer (PCa) after having had a radical prostatectomy harbored a higher grade or stage of the disease than previously thought raising concerns about the safety of managing PCa with active surveillance (AS).

“Active surveillance has been an option for monitoring cancer closely with the goal to allow a man to have the highest quality of life while delaying or possibly even completely avoiding invasive treatments,’ said Dr. David Samadi. “It can certainly be a viable method for monitoring men with prostate cancer that falls into the category of being low-grade or is considered to be very slow growing and not likely to spread. This study, however, found that some men who fall into this category may be concealing worse disease than what their prostate biopsy or clinical exam may be showing, meaning active surveillance may not be appropriate for them.”

The objective of this study was to examine the incidence and predictor of upgrading and upstaging among men with Gleason 3 + 4 FIR disease since it was unknown whether the active surveillance was always a safe option for patients with this stage of PCa. Using the National Cancer Database, the researchers studied more than 10,000 men diagnosed during 2010-2012 with Gleason 3 +4 tumors, with a prostate specific antigen (PSA) below 10 ng/mL, and CT1c-2c PCa with fewer than 50% positive biopsy cores who underwent radical prostatectomy.

“What the researchers found was that 30.3% of men with a Gleason score of 3 + 4 favorable intermediate-risk prostate cancer harbored advanced disease of a higher grade or stage,” explained Dr. Samadi. “The current guideline from the American Society of Clinical Oncology endorses the use of AS for select patients with low-volume Gleason 3 + 4 disease. What these findings suggest is that older men with a Gleason 3 + 4 FIR…

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