UCL Discovery
UCL home » Library Services » Electronic resources » UCL Discovery

Active Surveillance for Men Younger than 60 Years or with Intermediate-risk Localized Prostate Cancer. Descriptive Analyses of Clinical Practice in the Movember GAP3 Initiative

Remmers, Sebastiaan; Helleman, Jozien; Nieboer, Daan; Trock, Bruce; Hyndman, Matthew E; Moore, Caroline M; Gnanapragasam, Vincent; ... Roobol, Monique J; + view all (2022) Active Surveillance for Men Younger than 60 Years or with Intermediate-risk Localized Prostate Cancer. Descriptive Analyses of Clinical Practice in the Movember GAP3 Initiative. European Urology Open Science , 41 pp. 126-133. 10.1016/j.euros.2022.05.012. Green open access

[thumbnail of 1-s2.0-S2666168322006231-main.pdf]
Preview
Text
1-s2.0-S2666168322006231-main.pdf - Published Version

Download (1MB) | Preview

Abstract

BACKGROUND: Active surveillance (AS) is a management option for men diagnosed with low-risk prostate cancer. Opinions differ on whether it is safe to include young men (≤60 yr) or men with intermediate-risk disease. OBJECTIVE: To assess whether reasons for discontinuation, treatment choice after AS, and adverse pathology at radical prostatectomy (RP; N1, or ≥GG3, or ≥pT3) differ for men ≤60 yr or those with European Association of Urology (EAU) intermediate-risk disease from those for men >60 yr or those with EAU low-risk disease. DESIGN, SETTING, AND PARTICIPANTS: We analyzed data from 5411 men ≤60 yr and 14 959 men >60 yr, 14 064 men with low-risk cancer, and 2441 men with intermediate-risk cancer, originating from the GAP3 database (21 169 patients/27 cohorts worldwide). OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: Cumulative incidence curves were used to estimate the rates of AS discontinuation and treatment choice. RESULTS AND LIMITATIONS: The probability of discontinuation of AS due to disease progression at 5 yr was similar for men aged ≤60 yr (22%) and those >60 yr (25%), as well as those of any age with low-risk disease (24%) versus those with intermediate-risk disease (24%). Men with intermediate-risk disease are more prone to discontinue AS without evidence of progression than men with low-risk disease (at 1/5 yr: 5.9%/14.2% vs 2.0%/8.8%). Adverse pathology at RP was observed in 32% of men ≤60 yr compared with 36% of men >60 yr (p = 0.029), and in 34% with low-risk disease compared with 40% with intermediate-risk disease (p = 0.048). CONCLUSIONS: Our descriptive analysis of AS practices worldwide showed that the risk of progression during AS is similar across the age and risk groups studied. The proportion of adverse pathology was higher among men >60 yr than among men ≤60 yr. These results suggest that men ≤60 yr and those with EAU intermediate-risk disease should not be excluded from opting for AS as initial management. PATIENT SUMMARY: Data from 27 international centers reflecting daily clinical practice suggest that younger men or men with intermediate-risk prostate cancer do not hold greater risk for disease progression during active surveillance.

Type: Article
Title: Active Surveillance for Men Younger than 60 Years or with Intermediate-risk Localized Prostate Cancer. Descriptive Analyses of Clinical Practice in the Movember GAP3 Initiative
Location: Netherlands
Open access status: An open access version is available from UCL Discovery
DOI: 10.1016/j.euros.2022.05.012
Publisher version: https://doi.org/10.1016/j.euros.2022.05.012
Language: English
Additional information: © 2022 The Author(s). Published by Elsevier B.V. on behalf of European Association of Urology. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).
Keywords: Active surveillance, Disease progression, Prostatic neoplasms
UCL classification: UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Medical Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Medical Sciences > Div of Surgery and Interventional Sci > Department of Targeted Intervention
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences
UCL
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Medical Sciences > Div of Surgery and Interventional Sci
URI: https://discovery.ucl.ac.uk/id/eprint/10152419
Downloads since deposit
Loading...
35Downloads
Download activity - last month
Loading...
Download activity - last 12 months
Loading...
Downloads by country - last 12 months
Loading...

Archive Staff Only

View Item View Item