Research suggests that age can impact the risk of disease progression in low-risk prostate cancer managed with active surveillance, published in the Journal of Clinical Oncology (June 2017;35[17]:1898-1904).
Recent longitudinal trends in the United States show increasing use of active surveillance after prostate cancer diagnosis to approximately 40%. However, the suitability of younger patients for initial management with active surveillance has not been highly researched because of concerns for patient safety, longer burden of follow-up, and the belief that definitive treatment will eventually be necessary.
Michael Leapman, MD, school of medicine, Yale University, and colleagues conducted a study to examine the potential association of age with risk of biopsy-based Gleason score upgrade during active surveillance. Researchers identified 1433 low-risk patients managed with active surveillance beginning in 1992, with a minimum follow-up of 6 months from initial diagnostic biopsy. Patients were a median age 63 years at baseline (42% ≤ 60 years, n = 599; 58% > 60 years, n = 834), were followed for a median of 49 months, and 89% had a Gleason score at diagnosis of at least 3+3.
Researchers also assessed the association of age with related end points, including biopsy-determined progression, definitive treatment, and pathologic and biochemical outcomes after delayed radical prostatectomy.
Results of the analysis showed that patients diagnosed with prostate cancer at or before age 60 demonstrated a 7% reduction (55% vs 48%) in the rate of biopsy-determined progression during five years of active surveillance (P < .01). Cox regression analysis further showed that younger age was independently associated with lower risk of biopsy-based Gleason score upgrade (hazard ratio per 1-year decrease, 0.97; 95% CI, 0.956-0.983; P < .01). This association persisted in a separate analysis exclusive to the 66% of patients who met strict active surveillance inclusion criteria.
Additionally, researchers determined that age was not associated with time to treatment or subsequent clinical recurrence after delayed radical prostatectomy at five years. This finding, researchers suggest, reinforces the suitability of initial active surveillance for younger patients with low-risk prostate cancer.
“Longer follow-up is needed to assess more distant outcomes,” researchers concluded.—Zachary Bessette
