De-Escalation of Monitoring in Active Surveillance for Prostate Cancer: Results from the GAP3 Consortium - Beyond the Abstract
PCa patients eligible for AS have an acceptably low chance of developing distant metastases during observation, which often does not impact their prognosis. Patients with a low risk of dying from PCa may benefit from less intensive AS monitoring. We hypothesized that those at the highest risk of non-PCa mortality compared to PCa mortality could be good candidates for de-escalation of AS monitoring. In this study, we focused on over surveillance in AS. In other words, “too” active surveillance.
Our study found two key criteria—BMI greater than 25 and fewer than 11% positive cores at diagnostic prostate biopsy—that effectively stratify patients into groups with markedly different risks of PCa and non-PCa mortality over a 15-year period (34.2 times).1 The identified criteria led to 37% of the cohort being eligible for de-escalation of monitoring. Our findings suggest that patients meeting these criteria may have a significantly higher likelihood of dying from causes unrelated to PCa, justifying a reduction in the intensity of AS monitoring.
Our work contributes to the ongoing discourse on optimizing AS protocols. Future studies should focus on external validation of this model and its integration with tools, such as MRI and molecular biomarkers, to refine risk stratification further.
In conclusion, our study provides a framework for potentially reducing the intensity of monitoring during AS for PCa, which could have significant implications for patient care. By identifying patients who may safely transition to a less intensive monitoring regimen, we can help reduce the burden of AS while maintaining the safety and effectiveness of this important management strategy.
I believe that de-escalation of monitoring will be the keyword for AS in the future.
Written by Yoichiro Tohi, Department of Urology, Faculty of Medicine, Kagawa University, Kagawa, Japan
References:
Read the Abstract