A percentage of patients on active surveillance for clinically insignificant prostate cancer may be at risk of developing metastatic disease in the long term. A study published in The Journal of Urology has reported the clinical and pathological factors that correlate with risk of metastasis in this patient population.
Researchers led by Laurence Klotz, University of Toronto, Canada, analyzed 980 patients with prostate cancer undergoing active surveillance and grouped them based on risk using the prostate specific antigen test and Gleason score (GS) index. Median follow-up was 6.3 years.
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Metastatic disease developed in 3% of all patients (30 of 980), 15 of whom died from their disease, 4 of whom died from another cause, and 11 of whom were still living with metastasis at the close of the study. The most common regions of metastasis were the bone (18 patients [60%]) and the lymph nodes (13 patients [48%]).
A total of 211 patients (21.5%) were classified as intermediate risk, 14 of whom progressed to metastatic disease (6.6%). Intermediate risk was associated with a 2.7 times higher risk for metastasis. However, those in the intermediate risk group with a GS of 6 and PSA ≤10 ng/ml were not at increased risk for metastasis.
Specific factors found to be associated with increased risk of metastasis included doubling of PSA levels within 3 years, GS of 7, and a total of 3 or more positive biopsy cores.
The researchers concluded that clinicians should closely monitor PSA and GS activity when determining which patients with prostate cancer are candidates for active surveillance.
