Maya R Overland1, Samuel L Washington1, Peter R Carroll1, Matthew R Cooperberg1,2, Annika Herlemann1,3. 1. Department of Urology. 2. Department of Epidemiology and Biostatistics, University of California, San Francisco, UCSF - Helen Diller Family Comprehensive Cancer Center, San Francisco, California, USA. 3. Department of Urology, Ludwig-Maximilians-University of Munich, Munich, Germany.
Abstract
PURPOSE OF REVIEW: Active surveillance is becoming more widely accepted as an initial management option for carefully selected men with favorable intermediate-risk prostate cancer (PCa). As prospective active surveillance cohorts mature sufficiently to begin evaluating longer-term outcomes, consensus on more precise evidence-based guidelines is needed to identify the patient cohorts who may be safely managed with active surveillance and what the ideal surveillance protocol entails. RECENT FINDINGS: Long-term outcomes updates have suggested a trend toward worse 15-year survival outcomes for intermediate-risk patients on active surveillance compared with definitive treatment, but 'intermediate-risk' is a broad category and there is a subset of favorable intermediate-risk patients for whom survival outcomes remain equivalent. Promising updates to current risk stratification include consideration of genomic classifiers, advanced imaging and more nuanced interpretation of biopsy results. SUMMARY: Despite widespread acknowledgement of the pitfalls of overtreatment in clinically localized PCa, utilization of active surveillance in the intermediate-risk population remains marginal, in part due to the absence of easily interpretable consensus recommendations. As more long-term outcomes data become available for this subgroup, the field is now poised to refine the definition of favorable intermediate-risk patients for whom active surveillance is a safe, evidence-based first-line management option.
PURPOSE OF REVIEW: Active surveillance is becoming more widely accepted as an initial management option for carefully selected men with favorable intermediate-risk prostate cancer (PCa). As prospective active surveillance cohorts mature sufficiently to begin evaluating longer-term outcomes, consensus on more precise evidence-based guidelines is needed to identify the patient cohorts who may be safely managed with active surveillance and what the ideal surveillance protocol entails. RECENT FINDINGS: Long-term outcomes updates have suggested a trend toward worse 15-year survival outcomes for intermediate-risk patients on active surveillance compared with definitive treatment, but 'intermediate-risk' is a broad category and there is a subset of favorable intermediate-risk patients for whom survival outcomes remain equivalent. Promising updates to current risk stratification include consideration of genomic classifiers, advanced imaging and more nuanced interpretation of biopsy results. SUMMARY: Despite widespread acknowledgement of the pitfalls of overtreatment in clinically localized PCa, utilization of active surveillance in the intermediate-risk population remains marginal, in part due to the absence of easily interpretable consensus recommendations. As more long-term outcomes data become available for this subgroup, the field is now poised to refine the definition of favorable intermediate-risk patients for whom active surveillance is a safe, evidence-based first-line management option.
Authors: Emily Chan; Jesse K McKenney; Sarah Hawley; Dillon Corrigan; Heidi Auman; Lisa F Newcomb; Hilary D Boyer; Peter R Carroll; Matthew R Cooperberg; Eric Klein; Ladan Fazli; Martin E Gleave; Antonio Hurtado-Coll; Jeffry P Simko; Peter S Nelson; Ian M Thompson; Maria S Tretiakova; Dean Troyer; Lawrence D True; Funda Vakar-Lopez; Daniel W Lin; James D Brooks; Ziding Feng; Jane K Nguyen Journal: Mod Pathol Date: 2022-02-10 Impact factor: 8.209