2. UroToday Home
  3. Conference Highlights
  4. EAU 2017
  5. EAU 2017 - Prostate Cancer

EAU 2017

EAU 2017: Prospective validation of active surveillance: PRIAS

London, England (UroToday.com) The Prostate Cancer Research International Active Surveillance (PRIAS) study was started more than a decade ago to study the most optimal selection and follow-up of men on active surveillance (AS). Recently a report on 10 year follow-up was published in the European urology journal (December 2016) to evaluate if criteria used to recommend transition from AS to active treatment truly predicted unfavourable outcome on subsequent radical prostatectomy (RP). The conclusion of the study was that a substantial group of men discontinued AS without subsequent unfavorable tumor features on RP. As a result, the only criteria that were proposed as indicators for an immediate switch to active treatment, included Gleason upgrading and clinical stage T3.

Dr. Bangma presented a detailed description of the PRIAS study. This study is an observational study without any endpoint in time. It claims results that feed many guidelines. It is the most popular product in AS, having great impact on patients, doctors and society overall. However, it remains a subject biased by opinions.

Critical questions that were raised by Dr. Bangma regarding PRIAS project included whether the methods and results could be reproduced by others, if the inclusion criteria result in long lasting active surveillance, if the study method is influenced by geography, if it is practical enough, cost efficient and accepted.

The goal of PRIAS project was mainly to limit the amount of overtreatment, to study factors such as PSA velocity and pathological findings in RP specimens in regards to AS. Additionally, it aimed to study the effects of expectancy on the quality of life of patients. The hypothesis was that less than 5% of men managed by AS will develop clinical progression (evidenced by positive bone scan) during their lifetimes. The primary endpoint of this study was clinical progression, evidenced by metastasis (M1) on a bone scan. Secondary endpoints included the number of patients changing their treatment, PSA dynamics over time and prostate cancer specific mortality.

In the 10 year follow-up study 1% of men selected for AS died due to prostate cancer, 5% discontinued AS due to anxiety and fear of progression was shown to decrease over time. In total, 98% and 94% of all men on AS were biochemical failure, local recurrence, metastasis and prostate cancer death free at 5 and 10 years after diagnosis, respectively.

The PRIAS website (WWW.PRIAS-PROJECT.ORG) allows real world AS practice and today the PRIAS principles are followed by over 150 centers with over 6000 patients in over 20 countries, spanning 4 continents.

Presented by: Dr. Chris.H. Bangma, Rotterdam (NL)

Written by: Hanan Goldberg, MD, Urologic Oncology Fellow (SUO), University of Toronto

Twitter: @GoldbergHanan

at the #EAU17 -March 24-28, 2017- London, England