Active surveillance in favorable intermediate risk prostate cancer: outstanding questions and controversies

Abstract

Purpose of reviewActive surveillance has become the preferred management strategy for patients with low risk prostate cancer, but it is unclear if active surveillance can be safely extended to favorable intermediate risk (FIR) prostate cancer patients. Furthermore, defining a favorable intermediate risk prostate cancer population safe for active surveillance remains elusive due to paucity of high-level data in this population. This article serves to review relevant data, particularly the safety of active surveillance in grade group 2 patients, and what tools are available to aid in selecting a favorable subset of intermediate risk patients. Recent findingsActive surveillance studies with long-term data appear to report worsened survival outcomes in intermediate risk patients when compared to those undergoing definitive treatment, but there exists a subset of intermediate risk patients with nearly equivalent outcomes to low risk patients on active surveillance. Tools such as percentage and total length of Gleason pattern 4, tumor volume, prostate specific antigen density, magnetic resonance imaging, and genomic modifiers may help to select a favorable subset of intermediate risk prostate cancer appropriate for active surveillance.

Inference of core needle biopsy whole slide images requiring definitive therapy for prostate cancer

“…Our model (TL-Colon poorly ADC (x20, 512) and FS+WS) predicted indolent (Gleason pattern 3) and aggressive (Gleason pattern 4 and 5) lesions well after inspection of WSI heatmaps (Fig. 4,5,6). The model still had a few cases of false positive and false negative predictions (Fig.…”

“…As for the active surveillance, it consists in performing regular follow-ups of patients so as to be able to provide appropriate radical treatment for high-risk groups if necessary [4]. The criteria for active surveillance are highly controversial [2][3][4][5][6]. According to the Cancer Care Ontario (CCO) Guideline and American Society of Clinical Oncology (ASCO) Clinical Practice Guideline, it is generally accepted that active surveillance is applied when a prostate cancer is determined by biopsy and Gleason pattern 4 components account for less than 10% of the total cancer volume [2].…”

Inference of core needle biopsy whole slide images requiring definitive therapy for prostate cancer

“…As for the active surveillance, it consists in performing regular follow-ups of patients so as to be able to provide appropriate radical treatment for high-risk groups if necessary Morash et al (2015). The criteria for active surveillance are highly controversial Chen et al (2016); Morash et al (2015); Van Leenders et al (2020); Cyll et al (2022); Russell and Siddiqui (2022). According to the Cancer Care Ontario (CCO) Guideline and American Society of Clinical Oncology (ASCO) Clinical Practice Guideline, it is generally accepted that active surveillance is applied when a prostate cancer is determined by biopsy and Gleason pattern 4 components account for less than 10% of the total cancer volume Chen et al (2016).…”