Phoenix, Arizona (UroToday.com) Dr. Carlsson experiences the Sloan Kettering Cancer Center with active surveillance for long-term sequences. Most patients with low risk prostate cancer still have treatment, however, the active rate of surveillance in the United States over recent years has increased to me. Nearly 50% of low-risk patients. Interestingly, the rate of active supervision in Sweden is exceptionally high for low-risk patients (~ 80%) and for intermediate risk patients (~ 20%).
Many patients on active supervision seek "get rid of" or "improve" cancer. However, treatment for local prostate cancer often causes reductions in each functional area, and the increasing use of active supervision is essential in order to reduce the burden of depression. What is still needed is the estimates of long-term oncological results from potential contemporary cohorts of large-scale active surveillance.
At Sloan Kettering Memorial Center there are 2907 patients with low / intermediate risk prostate cancer that are treated with operational supervision between 2000-2017. In this cohort, 92% of patients had Gleason 6 disease (grade 1 group). Most patients had the inflexible disease (89%). The active surveillance protocol at Sloan Memorial Center includes PSA and 6-month digital rectal examination, prostrate MRI every 18 months, and prostate biopsy every 36 months.
Long-term progression has shown that 25% of men with Gleason 6 on active supervision are at risk of upgrading in five years, 36% on 10 years, and 41% at 15, as shown in figure 1.
Figure 1: Long-term risk of upgrading in men on active supervision:
The remaining probability of active supervision was high for low-risk patients (78% on 5 years, 64% on 10 years, and 57% at age 15). In total, there were 2/3 people who went on to radical prostatectomy treatment. The main reason for the change to treatment was a sequence of progression. The prevalence of fetastasis was very low in men with low-risk prostate cancer that were managed with active supervision (0% on five years, 1% on 10 years, and 5% at 15). Out of 2664 low-risk patients on active supervision, one man died of prostate cancer. The overall survival of these patients was very high, with 99% in five years, 94% at 10 years, and 78% at age 15 (as shown in figure 2)
Figure 2 General survival rates on long-term after-entitlement after 15 years:
This long-term experience of the Memorial Sloan Memorial Center confirms previous reports that active surveillance is a safe heart control strategy. However, it is important to remember that this needs to be done in tertiary cancer centers, with patients who have been selected appropriately, following a well defined and defined control strategy.
Submitted by: Sigrid Carlsson, MD, Ph.D., MPH, Assistant Resident Epidemiologist, Sloan Kettering Cancer Center Memorial
Written by: Hanan Goldberg, MD, Urology Oncology Fellow, SUO, University of Toronto, Princess Margaret's Cancer Center, @GoldbergHanan, at the 19th Annual Urology Oncology Association (SUO), November 28-30, 2018 – Phoenix, Arizona