There is no consensus on de-escalation of monitoring during active surveillance (AS) for prostate cancer (PCa). Our objective was to determine clinical criteria that can be used in decisions to reduce the intensity of AS monitoring.
The global prospective AS cohort from the Global Action Plan prostate cancer AS consortium was retrospectively analyzed. The 24656 patients with complete outcome data were considered. The primary goal was to develop a model identifying a subgroup with a high ratio of other-cause mortality (OCM) to PCa-specific mortality (PCSM). Nonparametric competing-risks models were used to estimate cause-specific mortality. We hypothesized that the subgroup with the highest OCM/PCSM ratio would be good candidates for de-escalation of AS monitoring.
Cumulative mortality at 15 yr, accounting for censoring, was 1.3% for PCSM, 11.5% for OCM, and 18.7% for death from unknown causes. We identified body mass index (BMI) >25 kg/m2 and <11% positive cores at initial biopsy as an optimal set of criteria for discriminating OCM from PCSM. The 15-yr OCM/PCSM ratio was 34.2 times higher for patients meeting these criteria than for those not meeting the criteria. According to these criteria, 37% of the cohort would be eligible for de-escalation of monitoring. Limitations include the retrospective nature of the study and the lack of external validation.
Our study identified BMI >25 kg/m2 and <11% positive cores at initial biopsy as clinical criteria for de-escalation of AS monitoring in PCa.
We investigated factors that could help in deciding on when to reduce the intensity of monitoring for patients on active surveillance for prostate cancer. We found that patients with higher BMI (body mass index) and lower prostate cancer volume may be good candidates for less intensive monitoring. This model could help doctors and patients in making decisions on active surveillance for prostate cancer.
European urology oncology. 2024 Jul 31 [Epub ahead of print]
Yoichiro Tohi, John M Sahrmann, Jaron Arbet, Takuma Kato, Lui Shiong Lee, Michael Peacock, Kevin Ginsburg, Christian Pavlovich, Peter Carroll, Chris H Bangma, Mikio Sugimoto, Paul C Boutros, Global Action Plan Prostate Cancer Active Surveillance (GAP3) Consortium
Department of Urology, Faculty of Medicine, Kagawa University, Kagawa, Japan. Electronic address: ., Jonsson Comprehensive Cancer Center, University of California-Los Angeles, Los Angeles, CA, USA; Institute for Precision Health, University of California-Los Angeles, Los Angeles, CA, USA; Department of Human Genetics, University of California-Los Angeles, Los Angeles, CA, USA; Department of Urology, David Geffen School of Medicine, University of California-Los Angeles, Los Angeles, CA, USA., Department of Urology, Faculty of Medicine, Kagawa University, Kagawa, Japan., Department of Urology, Sengkang General Hospital and Singapore General Hospital, Singapore., BC Cancer, University of British Columbia, Vancouver, Canada., Department of Urology, Wayne State University, Detroit, MI, USA., Department of Urology, James Buchanan Brady Urological Institute, Johns Hopkins University, Baltimore, MD, USA., Department of Urology, University California-San Francisco, San Francisco, CA, USA., Department of Urology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands.
PubMed http://www.ncbi.nlm.nih.gov/pubmed/39089946