Prognostic Value of the Intermediate-risk Feature in Men with Favorable Intermediate-risk Prostate Cancer: Implications for Active Surveillance
Background: Guidelines suggest that active surveillance (AS) may be considered for select patients with favorable intermediate-risk (fIR) prostate cancer. Objective: To compare the outcomes between fIR prostate cancer patients included by Gleason score (GS) or prostate-specific antigen (PSA). Most p...
| Main Authors: | , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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Elsevier
2023-04-01
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| Series: | European Urology Open Science |
| Subjects: | |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S2666168323000976 |
| _version_ | 1827968108027969536 |
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| author | Michael V. Sherer Austin J. Leonard Tyler J. Nelson P. Travis Courtney Kripa Guram Gustavo Rodrigues De Moraes Juan Javier-Desloges Christopher Kane Rana R. McKay Brent S. Rose Aditya Bagrodia |
| author_facet | Michael V. Sherer Austin J. Leonard Tyler J. Nelson P. Travis Courtney Kripa Guram Gustavo Rodrigues De Moraes Juan Javier-Desloges Christopher Kane Rana R. McKay Brent S. Rose Aditya Bagrodia |
| author_sort | Michael V. Sherer |
| collection | DOAJ |
| description | Background: Guidelines suggest that active surveillance (AS) may be considered for select patients with favorable intermediate-risk (fIR) prostate cancer. Objective: To compare the outcomes between fIR prostate cancer patients included by Gleason score (GS) or prostate-specific antigen (PSA). Most patients are classified with fIR disease due to either a 3 + 4 = 7 GS (fIR-GS) or a PSA level of 10–20 ng/ml (fIR-PSA). Previous research suggests that inclusion by GS 7 may be associated with worse outcomes. Design, setting, and participants: We conducted a retrospective cohort study of US veterans diagnosed with fIR prostate cancer from 2001 to 2015. Outcome measurements and statistical analysis: We compared the incidence of metastatic disease, prostate cancer–specific mortality (PCSM), all-cause mortality (ACM), and receipt of definitive treatment between fIR-PSA and fIR-GS patients managed with AS. Outcomes were compared with those of a previously published cohort of patients with unfavorable intermediate-risk disease using cumulative incidence function and Gray’s test for statistical significance. Results and limitations: The cohort included 663 men; 404 had fIR-GS (61%) and 249 fIR-PSA (39%). There was no evidence of difference in the incidence of metastatic disease (8.6% vs 5.8%, p = 0.77), receipt of definitive treatment (77.6% vs 81.5%, p = 0.43), PCSM (5.7% vs 2.5%, p = 0.274), and ACM (16.8% vs 19.1%, p = 0.14) between the fIR-PSA and fIR-GS groups at 10 yr. On multivariate regression, unfavorable intermediate-risk disease was associated with higher rates of metastatic disease, PCSM, and ACM. Limitations included varying surveillance protocols. Conclusions: There is no evidence of difference in oncological and survival outcomes between men with fIR-PSA and fIR-GS prostate cancer undergoing AS. Thus, presence of GS 7 disease alone should not exclude patients from consideration of AS. Shared decision-making should be utilized to optimize management for each patient. Patient summary: In this report, we compared the outcomes of men with favorable intermediate-risk prostate cancer in the Veterans Health Administration. We found no significant difference between survival and oncological outcomes. |
| first_indexed | 2024-04-09T18:16:04Z |
| format | Article |
| id | doaj.art-ce0a515b595e4192886bf1f947a77d45 |
| institution | Directory Open Access Journal |
| issn | 2666-1683 |
| language | English |
| last_indexed | 2024-04-09T18:16:04Z |
| publishDate | 2023-04-01 |
| publisher | Elsevier |
| record_format | Article |
| series | European Urology Open Science |
| spelling | doaj.art-ce0a515b595e4192886bf1f947a77d452023-04-13T04:27:08ZengElsevierEuropean Urology Open Science2666-16832023-04-01506167Prognostic Value of the Intermediate-risk Feature in Men with Favorable Intermediate-risk Prostate Cancer: Implications for Active SurveillanceMichael V. Sherer0Austin J. Leonard1Tyler J. Nelson2P. Travis Courtney3Kripa Guram4Gustavo Rodrigues De Moraes5Juan Javier-Desloges6Christopher Kane7Rana R. McKay8Brent S. Rose9Aditya Bagrodia10Department of Radiation Medicine and Applied Sciences, University of California San Diego, La Jolla, CA, USA; VA San Diego Healthcare System, La Jolla, CA, USADepartment of Urology, University of California San Diego, La Jolla, CA, USADepartment of Radiation Medicine and Applied Sciences, University of California San Diego, La Jolla, CA, USA; VA San Diego Healthcare System, La Jolla, CA, USADepartment of Radiation Medicine and Applied Sciences, University of California San Diego, La Jolla, CA, USA; VA San Diego Healthcare System, La Jolla, CA, USADepartment of Radiation Medicine and Applied Sciences, University of California San Diego, La Jolla, CA, USA; VA San Diego Healthcare System, La Jolla, CA, USADepartment of Radiation Medicine and Applied Sciences, University of California San Diego, La Jolla, CA, USADepartment of Urology, University of California San Diego, La Jolla, CA, USADepartment of Urology, University of California San Diego, La Jolla, CA, USADepartment of Radiation Medicine and Applied Sciences, University of California San Diego, La Jolla, CA, USADepartment of Radiation Medicine and Applied Sciences, University of California San Diego, La Jolla, CA, USA; VA San Diego Healthcare System, La Jolla, CA, USADepartment of Urology, University of California San Diego, La Jolla, CA, USA; Corresponding author. Department of Urology, University of California San Diego, 9400 Campus Point Drive, Suite 1-200, La Jolla, CA 92037, USA.Background: Guidelines suggest that active surveillance (AS) may be considered for select patients with favorable intermediate-risk (fIR) prostate cancer. Objective: To compare the outcomes between fIR prostate cancer patients included by Gleason score (GS) or prostate-specific antigen (PSA). Most patients are classified with fIR disease due to either a 3 + 4 = 7 GS (fIR-GS) or a PSA level of 10–20 ng/ml (fIR-PSA). Previous research suggests that inclusion by GS 7 may be associated with worse outcomes. Design, setting, and participants: We conducted a retrospective cohort study of US veterans diagnosed with fIR prostate cancer from 2001 to 2015. Outcome measurements and statistical analysis: We compared the incidence of metastatic disease, prostate cancer–specific mortality (PCSM), all-cause mortality (ACM), and receipt of definitive treatment between fIR-PSA and fIR-GS patients managed with AS. Outcomes were compared with those of a previously published cohort of patients with unfavorable intermediate-risk disease using cumulative incidence function and Gray’s test for statistical significance. Results and limitations: The cohort included 663 men; 404 had fIR-GS (61%) and 249 fIR-PSA (39%). There was no evidence of difference in the incidence of metastatic disease (8.6% vs 5.8%, p = 0.77), receipt of definitive treatment (77.6% vs 81.5%, p = 0.43), PCSM (5.7% vs 2.5%, p = 0.274), and ACM (16.8% vs 19.1%, p = 0.14) between the fIR-PSA and fIR-GS groups at 10 yr. On multivariate regression, unfavorable intermediate-risk disease was associated with higher rates of metastatic disease, PCSM, and ACM. Limitations included varying surveillance protocols. Conclusions: There is no evidence of difference in oncological and survival outcomes between men with fIR-PSA and fIR-GS prostate cancer undergoing AS. Thus, presence of GS 7 disease alone should not exclude patients from consideration of AS. Shared decision-making should be utilized to optimize management for each patient. Patient summary: In this report, we compared the outcomes of men with favorable intermediate-risk prostate cancer in the Veterans Health Administration. We found no significant difference between survival and oncological outcomes.http://www.sciencedirect.com/science/article/pii/S2666168323000976Favorable intermediate-risk prostate cancerActive surveillanceShared decision-making |
| spellingShingle | Michael V. Sherer Austin J. Leonard Tyler J. Nelson P. Travis Courtney Kripa Guram Gustavo Rodrigues De Moraes Juan Javier-Desloges Christopher Kane Rana R. McKay Brent S. Rose Aditya Bagrodia Prognostic Value of the Intermediate-risk Feature in Men with Favorable Intermediate-risk Prostate Cancer: Implications for Active Surveillance European Urology Open Science Favorable intermediate-risk prostate cancer Active surveillance Shared decision-making |
| title | Prognostic Value of the Intermediate-risk Feature in Men with Favorable Intermediate-risk Prostate Cancer: Implications for Active Surveillance |
| title_full | Prognostic Value of the Intermediate-risk Feature in Men with Favorable Intermediate-risk Prostate Cancer: Implications for Active Surveillance |
| title_fullStr | Prognostic Value of the Intermediate-risk Feature in Men with Favorable Intermediate-risk Prostate Cancer: Implications for Active Surveillance |
| title_full_unstemmed | Prognostic Value of the Intermediate-risk Feature in Men with Favorable Intermediate-risk Prostate Cancer: Implications for Active Surveillance |
| title_short | Prognostic Value of the Intermediate-risk Feature in Men with Favorable Intermediate-risk Prostate Cancer: Implications for Active Surveillance |
| title_sort | prognostic value of the intermediate risk feature in men with favorable intermediate risk prostate cancer implications for active surveillance |
| topic | Favorable intermediate-risk prostate cancer Active surveillance Shared decision-making |
| url | http://www.sciencedirect.com/science/article/pii/S2666168323000976 |
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