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The association between patient and disease characteristics, and the risk of disease progression in patients with prostate cancer on active surveillance

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A Letter to the Editor to this article was published on 26 March 2024

Abstract

Purpose

The objective of this study was to identify and assess patient and disease characteristics associated with an increased risk of disease progression in men with prostate cancer on active surveillance.

Methods

We studied patients with low-risk (ISUP GG1) or favorable intermediate-risk (ISUP GG2) PCa. All patients had at least one repeat biopsy. Disease progression was the primary outcome of this study, based on pathological upgrading. Univariate and multivariate Cox proportional hazard analyses were used to evaluate the association between covariates and disease progression.

Results

In total, 240 men were included, of whom 198 (82.5%) were diagnosed with low-risk PCa and 42 (17.5%) with favorable intermediate-risk PCa. Disease progression was observed in 42.9% (103/240) of men. Index lesion > 10 mm (HR = 2.85; 95% CI 1.74–4.68; p < 0.001), MRI (m)T-stage 2b/2c (HR = 2.52; 95% CI 1.16–5.50; p = 0.02), highest PI-RADS score of 5 (HR 3.05; 95% CI 1.48–6.28; p = 0.002) and a higher PSA level (HR 1.06; 95% CI 1.01–1.11; p = 0.014) at baseline were associated with disease progression on univariate analysis. Multivariate analysis showed no significant baseline predictors of disease progression.

Conclusion

In AS patients with low-risk or favorable intermediate-risk PCa, diameter of index lesion, MRI (m)T-stage, height of the PI-RADS score and the PSA level at baseline are significant predictors of disease progression to first repeat biopsy.

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References

  1. Mohler JL, Antonarakis ES, Armstrong AJ et al (2019) Prostate cancer, version 2.2019, NCCN clinical practice guidelines in oncology. J Natl Compr Cancer Netw. 17(5):479–505

    Article  CAS  Google Scholar 

  2. Kinsella N, Helleman J, Bruinsma S et al (2018) Active surveillance for prostate cancer: A systematic review of contemporary worldwide practices. Transl Androl Urol 7(1):83–97

    Article  PubMed  PubMed Central  Google Scholar 

  3. Yao SL, Grace LY (2002) Understanding and appreciating overdiagnosis in the PSA era. J Natl Cancer Inst 94(13):958–960

    Article  PubMed  Google Scholar 

  4. Loeb S, Bjurlin MA, Nicholson J et al (2014) Overdiagnosis and overtreatment of prostate cancer. Eur Urol 65(6):1046–1055

    Article  PubMed  PubMed Central  Google Scholar 

  5. Wei JT, Dunn RL, Sandler HM et al (2002) Comprehensive comparison of health-related quality of life after contemporary therapies for localized prostate cancer. J Clin Oncol 20(2):557–566

    Article  PubMed  Google Scholar 

  6. Al Hussein Al Awamlh B, Patel N, Ma X et al (2021) Variation in the use of active surveillance for low-risk prostate cancer across US census regions. Front Oncol 11:64488

    Article  Google Scholar 

  7. Bokhorst LP, Alberts AR, Rannikko A et al (2015) Compliance rates with the Prostate Cancer Research International Active Surveillance (PRIAS) protocol and disease reclassification in noncompliers. Eur Urol 68(5):814–821

    Article  PubMed  Google Scholar 

  8. Ploussard G, Epstein JI, Montironi R et al (2011) The contemporary concept of significant versus insignificant prostate cancer. Eur Urol 20(2):291–303

    Article  Google Scholar 

  9. Cooperberg MR, Carroll PR, Klotz L (2011) Active surveillance for prostate cancer: Progress and promise. J Clin Oncol 29(27):3669–3676

    Article  PubMed  Google Scholar 

  10. Williams C, Khondakar NR, Daneshvar MA et al (2021) The risk of prostate cancer progression in active surveillance patients with bilateral disease detected by combined magnetic resonance imaging-fusion and systematic biopsy. J Urol 206(5):1157–1165

    Article  PubMed  PubMed Central  Google Scholar 

  11. Eggener SE, Rumble RB, Armstrong AJ et al (2020) Molecular biomarkers in localized prostate cancer: ASCO guideline. J Clin Oncol 38(13):1474–1494

    Article  PubMed  Google Scholar 

  12. Black MH, Li S, LaDuca H et al (2020) Validation of a prostate cancer polygenic risk score. Prostate 80(15):1314–1321

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  13. Loeb S, Bruinsma SM, Nicholson J et al (2015) Active surveillance for prostate cancer: a systematic review of clinicopathologic variables and biomarkers for risk stratification. Eur Urol 67(4):619–626

    Article  PubMed  Google Scholar 

  14. Olivier J, Li W, Nieboer D et al (2022) Prostate cancer patients under active surveillance with a suspicious magnetic resonance imaging finding are at increased risk of needing treatment: results of the movember foundation’s Global Action Plan Prostate Cancer Active Surveillance (GAP3) Consortium. Eur Urol Open Sci 35:59–67

    Article  PubMed  PubMed Central  Google Scholar 

  15. Iremashvili V, Soloway MS, Rosenberg DL et al (2012) Clinical and demographic characteristics associated with prostate cancer progression in patients on active surveillance. J Urol 187(5):1594–1599

    Article  PubMed  Google Scholar 

  16. Barayan GA, Brimo F, Bégin LR et al (2014) Factors influencing disease progression of prostate cancer under active surveillance: a McGill University Health Center cohort. BJU Int 114(6b):e99–e104

    Article  CAS  PubMed  Google Scholar 

  17. Iremashvili V, Manoharan M, Rosenberg DL et al (2013) Biopsy features associated with prostate cancer progression in active surveillance patients: comparison of three statistical models. BJU Int 111(4):574–579

    Article  PubMed  Google Scholar 

  18. Kotb AF, Tanguay S, Luz MA et al (2011) Relationship between initial PSA density with future PSA kinetics and repeat biopsies in men with prostate cancer on active surveillance. Prostate Cancer Prostatic Dis 14(1):53–57

    Article  CAS  PubMed  Google Scholar 

  19. Tseng KS, Landis P, Epstein JI et al (2010) Risk stratification of men choosing surveillance for low risk prostate cancer. J Urol 183(5):1779–1785

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  20. Bul M, Zhu X, Valdagni R et al (2013) Active surveillance for low-risk prostate cancer worldwide: the PRIAS study. Eur Urol 63(4):597–603

    Article  PubMed  Google Scholar 

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Funding

No funding was received for conducting this study.

Author information

Authors and Affiliations

  1. Department of Urology, OLVG, PO Box 95500, 1090 HM, Amsterdam, The Netherlands

    Matthijs Duijn

  2. Andros Clinics, Arnhem, The Netherlands

    Matthijs Duijn, Theo M. de Reijke, Kurdo Barwari, Jos Immerzeel & Jelle O. Barentsz

  3. Department of Urology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands

    Theo M. de Reijke, Marias J. Hagens & Auke Jager

  4. Department of Urology, Netherlands Cancer Institute (NCI), Amsterdam, The Netherlands

    Kurdo Barwari & Marias J. Hagens

  5. Prostate Cancer Network the Netherlands, Amsterdam, The Netherlands

    Marias J. Hagens

  6. Department of Urology, Spaarne Gasthuis, Hoofddorp, The Netherlands

    Sybren P. Rynja

Authors
  1. Matthijs Duijn
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  2. Theo M. de Reijke
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  3. Kurdo Barwari
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  4. Marias J. Hagens
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  5. Sybren P. Rynja
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  6. Jos Immerzeel
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  7. Jelle O. Barentsz
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  8. Auke Jager
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Contributions

Conceptualization: MD, AJ, TdR. Methodology: MD, AJ. Formal analysis and investigation: MD, AJ. Writing—original draft preparation: MD, AJ. Writing—review and editing: TdR, KB, MH, JB, JI. Resources: SR. Supervision: TdR, KB, JB, JI.

Corresponding author

Correspondence to Matthijs Duijn.

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Conflict of interest

In addition, all authors certify that they have no affiliations with or involvement in any organization or entity with any financial interest or non-financial interest in the subject matter or materials discussed in this manuscript.

Ethical approval

Ethical approval was waived by the local Ethics Committee of AUMC-location VUmc in view of the retrospective nature of the study and all the procedures being performed were part of the routine care.

Informed consent

Informed consent was obtained from all individual participants included in the study.

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Duijn, M., de Reijke, T.M., Barwari, K. et al. The association between patient and disease characteristics, and the risk of disease progression in patients with prostate cancer on active surveillance. World J Urol 42, 87 (2024). https://doi.org/10.1007/s00345-024-04805-9

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  • DOI: https://doi.org/10.1007/s00345-024-04805-9

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