Metastasis and Mortality in Men With Low- and Intermediate-Risk Prostate Cancer on Active Surveillance
BACKGROUND: Active surveillance (AS) is a safe treatment option for men with low-risk, localized prostate cancer. However, the safety of AS for patients with intermediate-risk prostate cancer remains unclear.
PATIENTS AND METHODS: We identified men with NCCN-classified low-risk and favorable and unfavorable intermediate-risk prostate cancer diagnosed between 2001 and 2015 and initially managed with AS in the Veterans Health Administration. We analyzed progression to definitive treatment, metastasis, prostate cancer-specific mortality (PCSM), and all-cause mortality using cumulative incidences and multivariable competing-risks regression.
RESULTS: The cohort included 9,733 men, of whom 1,007 (10.3%) had intermediate-risk disease (773 [76.8%] favorable, 234 [23.2%] unfavorable), followed for a median of 7.6 years. The 10-year cumulative incidence of metastasis was significantly higher for patients with favorable (9.6%; 95% CI, 7.1%-12.5%; P<.001) and unfavorable intermediate-risk disease (19.2%; 95% CI, 13.4%-25.9%; P<.001) than for those with low-risk disease (1.5%; 95% CI, 1.2%-1.9%). The 10-year cumulative incidence of PCSM was also significantly higher for patients with favorable (3.7%; 95% CI, 2.3%-5.7%; P<.001) and unfavorable intermediate-risk disease (11.8%; 95% CI, 6.8%-18.4%; P<.001) than for those with low-risk disease (1.1%; 95% CI, 0.8%-1.4%). In multivariable competing-risks regression, favorable and unfavorable intermediate-risk patients had significantly increased risks of metastasis and PCSM compared with low-risk patients (all P<.001).
CONCLUSIONS: Compared with low-risk patients, those with favorable and unfavorable intermediate-risk prostate cancer managed with AS are at increased risk of metastasis and PCSM. AS may be an appropriate option for carefully selected patients with favorable intermediate-risk prostate cancer, though identification of appropriate candidates and AS protocols should be tested in future prospective studies.
| Medienart: |
E-Artikel |
|---|
| Erscheinungsjahr: |
2022 |
|---|---|
| Erschienen: |
2022 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:20 |
|---|---|
| Enthalten in: |
Journal of the National Comprehensive Cancer Network : JNCCN - 20(2022), 2 vom: 07. Feb., Seite 151-159 |
| Sprache: |
Englisch |
|---|
| Beteiligte Personen: |
Courtney, P Travis [VerfasserIn] |
|---|
| Links: |
|---|
| Themen: |
Journal Article |
|---|
| Anmerkungen: |
Date Completed 21.03.2022 Date Revised 05.08.2023 published: Print Citation Status MEDLINE |
|---|
| doi: |
10.6004/jnccn.2021.7065 |
|---|
| funding: |
|
|---|---|
| Förderinstitution / Projekttitel: |
|
| PPN (Katalog-ID): |
NLM336629524 |
|---|
| LEADER | 01000naa a22002652 4500 | ||
|---|---|---|---|
| 001 | NLM336629524 | ||
| 003 | DE-627 | ||
| 005 | 20231225232558.0 | ||
| 007 | cr uuu---uuuuu | ||
| 008 | 231225s2022 xx |||||o 00| ||eng c | ||
| 024 | 7 | |a 10.6004/jnccn.2021.7065 |2 doi | |
| 028 | 5 | 2 | |a pubmed24n1122.xml |
| 035 | |a (DE-627)NLM336629524 | ||
| 035 | |a (NLM)35130495 | ||
| 035 | |a (PII)jnccn21084 | ||
| 040 | |a DE-627 |b ger |c DE-627 |e rakwb | ||
| 041 | |a eng | ||
| 100 | 1 | |a Courtney, P Travis |e verfasserin |4 aut | |
| 245 | 1 | 0 | |a Metastasis and Mortality in Men With Low- and Intermediate-Risk Prostate Cancer on Active Surveillance |
| 264 | 1 | |c 2022 | |
| 336 | |a Text |b txt |2 rdacontent | ||
| 337 | |a ƒaComputermedien |b c |2 rdamedia | ||
| 338 | |a ƒa Online-Ressource |b cr |2 rdacarrier | ||
| 500 | |a Date Completed 21.03.2022 | ||
| 500 | |a Date Revised 05.08.2023 | ||
| 500 | |a published: Print | ||
| 500 | |a Citation Status MEDLINE | ||
| 520 | |a BACKGROUND: Active surveillance (AS) is a safe treatment option for men with low-risk, localized prostate cancer. However, the safety of AS for patients with intermediate-risk prostate cancer remains unclear | ||
| 520 | |a PATIENTS AND METHODS: We identified men with NCCN-classified low-risk and favorable and unfavorable intermediate-risk prostate cancer diagnosed between 2001 and 2015 and initially managed with AS in the Veterans Health Administration. We analyzed progression to definitive treatment, metastasis, prostate cancer-specific mortality (PCSM), and all-cause mortality using cumulative incidences and multivariable competing-risks regression | ||
| 520 | |a RESULTS: The cohort included 9,733 men, of whom 1,007 (10.3%) had intermediate-risk disease (773 [76.8%] favorable, 234 [23.2%] unfavorable), followed for a median of 7.6 years. The 10-year cumulative incidence of metastasis was significantly higher for patients with favorable (9.6%; 95% CI, 7.1%-12.5%; P<.001) and unfavorable intermediate-risk disease (19.2%; 95% CI, 13.4%-25.9%; P<.001) than for those with low-risk disease (1.5%; 95% CI, 1.2%-1.9%). The 10-year cumulative incidence of PCSM was also significantly higher for patients with favorable (3.7%; 95% CI, 2.3%-5.7%; P<.001) and unfavorable intermediate-risk disease (11.8%; 95% CI, 6.8%-18.4%; P<.001) than for those with low-risk disease (1.1%; 95% CI, 0.8%-1.4%). In multivariable competing-risks regression, favorable and unfavorable intermediate-risk patients had significantly increased risks of metastasis and PCSM compared with low-risk patients (all P<.001) | ||
| 520 | |a CONCLUSIONS: Compared with low-risk patients, those with favorable and unfavorable intermediate-risk prostate cancer managed with AS are at increased risk of metastasis and PCSM. AS may be an appropriate option for carefully selected patients with favorable intermediate-risk prostate cancer, though identification of appropriate candidates and AS protocols should be tested in future prospective studies | ||
| 650 | 4 | |a Journal Article | |
| 650 | 4 | |a Research Support, N.I.H., Extramural | |
| 650 | 4 | |a Research Support, U.S. Gov't, Non-P.H.S. | |
| 700 | 1 | |a Deka, Rishi |e verfasserin |4 aut | |
| 700 | 1 | |a Kotha, Nikhil V |e verfasserin |4 aut | |
| 700 | 1 | |a Cherry, Daniel R |e verfasserin |4 aut | |
| 700 | 1 | |a Salans, Mia A |e verfasserin |4 aut | |
| 700 | 1 | |a Nelson, Tyler J |e verfasserin |4 aut | |
| 700 | 1 | |a Kumar, Abhishek |e verfasserin |4 aut | |
| 700 | 1 | |a Luterstein, Elaine |e verfasserin |4 aut | |
| 700 | 1 | |a Yip, Anthony T |e verfasserin |4 aut | |
| 700 | 1 | |a Nalawade, Vinit |e verfasserin |4 aut | |
| 700 | 1 | |a Parsons, J Kellogg |e verfasserin |4 aut | |
| 700 | 1 | |a Kader, A Karim |e verfasserin |4 aut | |
| 700 | 1 | |a Stewart, Tyler F |e verfasserin |4 aut | |
| 700 | 1 | |a Rose, Brent S |e verfasserin |4 aut | |
| 773 | 0 | 8 | |i Enthalten in |t Journal of the National Comprehensive Cancer Network : JNCCN |d 2003 |g 20(2022), 2 vom: 07. Feb., Seite 151-159 |w (DE-627)NLM156397676 |x 1540-1413 |7 nnns |
| 773 | 1 | 8 | |g volume:20 |g year:2022 |g number:2 |g day:07 |g month:02 |g pages:151-159 |
| 856 | 4 | 0 | |u http://dx.doi.org/10.6004/jnccn.2021.7065 |3 Volltext |
| 912 | |a GBV_USEFLAG_A | ||
| 912 | |a GBV_NLM | ||
| 951 | |a AR | ||
| 952 | |d 20 |j 2022 |e 2 |b 07 |c 02 |h 151-159 | ||