Comparison of Outcomes of Active Surveillance in Intermediate-Risk Versus Low-Risk Localised Prostate Cancer Patients: A Systematic Review and Meta-Analysis

Abstract

Currently, there is no clear consensus regarding the role of active surveillance (AS) in the management of intermediate-risk prostate cancer (IRPC) patients. We aim to analyse data from the available literature on the outcomes of AS in the management of IRPC patients and compare them with low-risk prostate cancer (LRPC) patients. A comprehensive literature search was performed, and relevant data were extracted. Our primary outcome was treatment-free survival, and secondary outcomes were metastasis-free survival, cancer-specific survival, and overall survival. The DerSimonian–Laird random-effects method was used for the meta-analysis. Out of 712 studies identified following an initial search, 25 studies were included in the systematic review. We found that both IRPC and LRPC patients had nearly similar 5, 10, and 15 year treatment-free survival rate, 5 and 10 year metastasis-free survival rate, and 5 year overall survival rate. However, cancer-specific survival rates at 5, 10, and 15 years were significantly lower in IRPC compared to LRPC group. Furthermore, IRPC patients had significantly inferior long-term overall survival rate (10 and 15 year) and metastasis-free survival rate (15 year) compared to LRPC patients. Both the clinicians and the patients can consider this information during the informed decision-making process before choosing AS.

A Systematic Review on Prostate-Specific Membrane Antigen Positron Emission Tomography (PSMA PET) Evaluating Localized Low- to Intermediate-Risk Prostate Cancer: A Tool to Improve Risk Stratification for Active Surveillance?

“…There is still a lack of consensus on criteria for the selection of intermediate-risk PCa for active surveillance as this cohort consists of a heterogeneous group of patients. Careful selection of intermediate-risk PCa is paramount as it is known to have worse outcomes compared to low-risk PCa on active surveillance [9]. The concern is if the disease has been under-staged during the initial biopsy.…”

“…However, there is a lack of consensus on which subgroup of intermediate-risk PCa patients is best suited for active surveillance and criteria to progress to active treatment. Some intermediate-risk PCa patients undergoing active surveillance have been shown to have worse overall survival and metastatic-free survival when compared to low-risk PCa patients [9]. Additionally, close to one-third of patients on active surveillance develop disease progression which may require active treatment [10].…”

The Current Therapeutic Landscape for Metastatic Prostate Cancer

“…For patients with localized low or intermediate risk PC, and on active surveillance (AS; deferred treatment), the fifteen-year treatment free survival rate is approximately 92%. In particular, patients with intermediate risk PC showed significantly lower fifteen-year metastasis-free survival rate, i.e., 10% lower when compared to patients with low risk PC, and a 13% reduction in ten-year overall survival rate when compared to patients with low risk PC [ 4 ]. Many of these patients diagnosed with localized PC eventually recur to develop metastatic disease, indicating that there is an unmet need for effective therapies targeting metastatic PC.…”