Dmitry Enikeev1, Andrey Morozov2, Mark Taratkin2, Eric Barret3, Vasiliy Kozlov4, Nirmish Singla5, Juan Gomez Rivas6, Alexey Podoinitsin7, Vitaly Margulis5, Petr Glybochko2. 1. Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russia. Electronic address: dvenikeev@gmail.com. 2. Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russia. 3. Department of Urology, Institut Mutualiste Montsouris, Paris, France. 4. Department of Public Health and Healthcare, Sechenov University, Moscow, Russia. 5. Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX. 6. Department of Urology, La Paz University Hospital, Madrid, Spain. 7. Moscow Regional Research and Clinical Institute MONIKI n.a. M.F. Vladimirskiy, Moscow, Russia.
Abstract
INTRODUCTION: Current guidelines allow active surveillance for intermediate-risk prostate cancer patients but do not provide comprehensive recommendations for selection. We performed a systematic review and meta-analysis of outcomes for active surveillance in intermediate- and low-risk groups. METHODS: We performed a systematic literature search of intermediate-risk localized prostate cancer patients undergoing active surveillance using 3 literature search engines (Medline, Web of Science, and Scopus) over the past 10 years. The primary outcome was the percentage of patients who remain under surveillance. Secondary outcomes included cancer-specific survival, overall survival, and metastasis-free survival. For articles including both low- and intermediate-risk patients undergoing active surveillance, comparisons between the two groups were made. RESULTS: The proportion of patients who remained on active surveillance was comparable between the low- and intermediate-risk groups after 10 and 15 years' follow-up (odds ratio [OR], 0.97; 95% confidence interval [CI], 0.83-1.14; and OR, 0.86; 95% CI, 0.65-1.13). Cancer-specific survival was worse in the intermediate-risk group after 10 years (OR, 0.47; 95% CI, 0.31-0.69) and 15 years (OR, 0.34; 95% CI, 0.2-0.58). The overall survival rate showed no statistical difference at 5 years' follow-up (OR, 0.84; 95% CI, 0.45-1.57) but was worse in the intermediate-risk group after 10 years (OR, 0.43; 95% CI, 0.35-0.53). Metastases-free survival did not significantly differ after 5 years (OR, 0.55; 95% CI, 0.2-1.53) and was worse in the intermediate-risk group after 10 years (OR, 0.46; 95% CI, 0.28-0.77). CONCLUSION: Active surveillance could be offered to patients with intermediate-risk prostate cancer. However, they should be informed of the need for regular monitoring and the possibility of discontinuation as a result of a higher rate of progression. Available data indicate that 5-year survival rates between intermediate- and low-risk patients do not differ; 10-year survival rates are worse. To assess the long-term effectiveness and safety of active surveillance, it is necessary to develop unified algorithms for patient selection and management, and to prospectively conduct studies with long-term surveillance.
INTRODUCTION: Current guidelines allow active surveillance for intermediate-risk prostate cancer patients but do not provide comprehensive recommendations for selection. We performed a systematic review and meta-analysis of outcomes for active surveillance in intermediate- and low-risk groups. METHODS: We performed a systematic literature search of intermediate-risk localized prostate cancer patients undergoing active surveillance using 3 literature search engines (Medline, Web of Science, and Scopus) over the past 10 years. The primary outcome was the percentage of patients who remain under surveillance. Secondary outcomes included cancer-specific survival, overall survival, and metastasis-free survival. For articles including both low- and intermediate-risk patients undergoing active surveillance, comparisons between the two groups were made. RESULTS: The proportion of patients who remained on active surveillance was comparable between the low- and intermediate-risk groups after 10 and 15 years' follow-up (odds ratio [OR], 0.97; 95% confidence interval [CI], 0.83-1.14; and OR, 0.86; 95% CI, 0.65-1.13). Cancer-specific survival was worse in the intermediate-risk group after 10 years (OR, 0.47; 95% CI, 0.31-0.69) and 15 years (OR, 0.34; 95% CI, 0.2-0.58). The overall survival rate showed no statistical difference at 5 years' follow-up (OR, 0.84; 95% CI, 0.45-1.57) but was worse in the intermediate-risk group after 10 years (OR, 0.43; 95% CI, 0.35-0.53). Metastases-free survival did not significantly differ after 5 years (OR, 0.55; 95% CI, 0.2-1.53) and was worse in the intermediate-risk group after 10 years (OR, 0.46; 95% CI, 0.28-0.77). CONCLUSION: Active surveillance could be offered to patients with intermediate-risk prostate cancer. However, they should be informed of the need for regular monitoring and the possibility of discontinuation as a result of a higher rate of progression. Available data indicate that 5-year survival rates between intermediate- and low-risk patients do not differ; 10-year survival rates are worse. To assess the long-term effectiveness and safety of active surveillance, it is necessary to develop unified algorithms for patient selection and management, and to prospectively conduct studies with long-term surveillance.
Authors: Auke Jager; Luigi A M J G van Riel; Arnoud W Postema; Theo M de Reijke; Tim M van der Sluis; Jorg R Oddens Journal: Ther Adv Urol Date: 2022-07-26
Authors: Ekaterina Laukhtina; Reza Sari Motlagh; Keiichiro Mori; Fahad Quhal; Victor M Schuettfort; Hadi Mostafaei; Satoshi Katayama; Nico C Grossmann; Guillaume Ploussard; Pierre I Karakiewicz; Alberto Briganti; Mohammad Abufaraj; Dmitry Enikeev; Benjamin Pradere; Shahrokh F Shariat Journal: World J Urol Date: 2021-05-28 Impact factor: 4.226