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JU INSIGHT: The Use and Short-term Outcomes of Active Surveillance in Men With National Comprehensive Cancer Network Favorable Intermediate-risk Prostate Cancer: The Initial Michigan Urological Surgery Improvement Collaborative Experience

By: Roshan Paudel, MD, MPH; Raghav Madan, MD; Ji Qi, MS; Stephanie Ferrante; Michael L. Cher, MD; Brian R. Lane, MD, PHD, FACS; Arvin K. George, MD; Alice Semerjian, MD; Kevin B. Ginsburg, MD, MS | Posted on: 17 Jan 2023

Paudel R, Madan R, Qi J, et al. The use and short-term outcomes of active surveillance in men with National Comprehensive Cancer Network favorable intermediate-risk prostate cancer: the initial Michigan Urological Surgery Improvement Collaborative experience. J Urol. 2023;209(1):170-179.

Study Need and Importance

There is a lack of real-world evidence on the use of active surveillance (AS) for favorable intermediate-risk prostate cancer (FIRPC) from diverse clinical practice settings. Further, little is known about the short-term oncologic outcomes for men with FIRPC who receive up-front treatment vs those who delay radical prostatectomy (RP). We retrospectively reviewed the Michigan Urological Surgery Improvement Collaborative data to assess the use of AS for men diagnosed with FIRPC and investigated short-term outcomes including adverse pathology and time to biochemical recurrence for those who underwent radical prostatectomy from 2012 to 2020.

Figure. Kaplan-Meier survival curves estimating biochemical recurrence-free survival for men with favorable intermediate-risk prostate cancer undergoing immediate and delayed radical prostatectomy (RP).

What We Found

We found considerable variability in the use of AS for men with FIPRC by practice ranging from 8% to 65% (23% to 85% for Grade Group [GG] 1 and 8% to 57% for GG2 disease). The 5-year treatment-free probability for those managed with AS was 63% overall and 73% for GG1 and 57% for GG2 disease. In risk-adjusted models, men with delayed RP had a higher risk of adverse pathology (46% vs 32%) but had similar rates of biochemical recurrence (22% vs 14%) to those who received immediate treatment (see Figure).

Limitations

The present study has limitations that are inherent to observational designs, including selection bias. Since the Michigan Urological Surgery Improvement Collaborative is a relatively new surgical registry, we were limited to reporting short-term oncologic outcomes for surgical patients only. Other limitations include lack of standardization in AS follow-up care as well as the inconsistent criteria for transition from AS to treatment.

Interpretation for Patient Care

Our study shows that men who delayed RP had similar oncologic outcomes to men undergoing up-front treatment, suggesting that many men with FIRPC can safely avoid radical treatment for years without compromising the survival benefit associated with radical treatment.

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