Active Surveillance For Low-Risk Prostate Cancer Does Not Shorten Life

May 18, 2015— AUA, New Orleans. A study of medical records of nearly 10,000 patients with prostate cancer shows that active surveillance (the updated form of watchful waiting) is suitable for most men with low-risk disease. Twelve to 15 years after diagnosis, these men are no more likely to die of prostate cancer than of other conditions and diseases. By contrast, the study shows, to avoid dying of prostate cancer men with high-risk disease may require aggressive "multimodal treatment" including surgery.

This study, carried out over years, was presented at the American Urological Association Annual Meeting from May 15 – 19.

Matthew Cooperberg, MDMatthew Cooperberg, MD, MPH and Peter R. Carroll, MD, MPH of the University of California, San Francisco analyzed extended follow-up in a large, community-based prostate cancer registry called CaPSURE, which has been collecting data on men managed at 47 US clinical sites, primarily community-based, since 1995.

Primary treatment was determined, and cancer-specific mortality (i.e. deaths due to prostate cancer) were totaled for all the men. Adjustments were made for each patient's age and relative risk of death as summarized by the Cancer of the Prostate Risk Assessment (CAPRA) score or the Kattan preoperative nomogram.

Of 9912 men with known treatment and complete risk stratification data, 426 (4.3%) died of prostate cancer a median of 86 months (7 years one month) after diagnosis. Median follow-up was 61 months (5 years one month).

Mortality rates rose sharply beyond 12 years of follow-up. For men with low-risk disease, death from prostate cancer was unlikely regardless of whichever type of treatment they received.

For men with higher-risk disease, substantial differences favored local treatment in general (i.e. focused on the prostate) and surgical removal of the prostate by radical prostatectomy in particular.

Brachytherapy and external beam radiation yielded similar results. Primary hormonal therapy results were similar to those seen for active surveillance.

Dr Cooperberg concluded that the results support a management paradigm including active surveillance for most men with low-risk disease and aggressive multimodal treatment including surgery for men with high-risk prostate cancer.

The method of analyzing cases in the CaPSURE registry was adopted, Dr. Cooperberg explained, because randomized trials comparing different active treatments for localized prostate cancer have not been completed. Prior to this study, a number of other recent studies have reported comparative outcomes using a variety of data sources, generally focusing on surgery and external beam radiation.

Sources and Contacts

Matthew R. Cooperberg, MD, MPH is Associate Professor of Urology; Epidemiology & Biostatistics, Helen Diller Family Chair in Urology, UCSF

Peter Carroll, MD is Chair, Urology Schoool, UCSF School of Medicine

This was presented at the AUA meeting, Monday, May 18, 2015 1:00 PM-3:00 PM
Prostate Cancer: Localized VI, PD43-01: "Long-term comparative mortality outcomes across different primary treatments for prostate cancer"
Matthew Cooperberg*, Peter Carroll, SAN FRANCISCO, CA, Abstract: PD43-01
A full scale image of the chart at the top of this article can be downloaded from a link accompanying the absctract.