Wednesday , December 1 2021

Long Term Results of Active Surveillance for Prostate Cancer – Memorial Sloan Kettering Cancer Center Experience



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Phoenix, Arizona (UroToday.com) Carlsson presented the experience of Memorial Sloan Kettering Cancer Center with active surveillance in a long-term follow-up. While most patients with low-risk prostate cancer have discontinued treatment, active surveillance in the United States has increased in recent years to almost 50% of low-risk patients. Interestingly, the active surveillance rate in Sweden is very high for low-risk patients (~ 80%) and for moderate-risk patients (~ 20%).

In the active follow-up, many patients aim to ”get rid Aktif or” treat ”. However, treatment for localized prostate cancer is commonly associated with a reduction in all functional areas, and the use of active surveillance to reduce overactive load should be increased. What is still needed is an estimate of long-term oncological outcomes from the large-scale contemporary prospective cohorts of active surveillance.

Memorial Sloan Kettering Cancer Center has 2907 patients with low / medium risk prostate cancer treated with active surveillance between 2000 and 2017. In this cohort, 92% of patients had Gleason 6 disease (grade 1 group). Most patients had nonpalpable disease (89%). The active surveillance protocol in the Memorial Sloan Kettering Cancer Center includes PSA and digital rectal examination every 6 months, prostate MRI every 18 months, and prostate biopsy every 36 months.

Long-term follow-up showed that 25% of Gleason 6 men in active follow-up had a risk of an increase of 41% in 10% and 10% in 10% and 10% in 10 years.

UroToday Risk of prolonged upgrades in men under active supervision
Figure 1: Long-term risk increase in men in active follow-up:

The likelihood of active follow-up was high for low-risk patients (78% in 5 years, 64% in 10 years and 57% in 15 years). In total, 2/3 of men who received treatment underwent radical prostatectomy. The main reason for the transition to treatment was to move forward. The incidence of metastasis in men with low-risk prostate cancer managed by active surveillance was very low (0, 10% in 5 years and 5% in 15 years). One of the 2664 low-risk patients under active surveillance, a man died of prostate cancer. The overall survival of these patients was very high, 99% at 5 years, 94% at 10 years and 78% at 15 years (as shown in Figure 2).

Long-term overall survival rates after 15 years of UroToday
Figure 2- Overall survival rates in long-term follow-up after 15 years:

This long-term experience of the Memorial Sloan Kettering Cancer Center confirms that previous reports have enabled active surveillance as an oncologically safe management strategy. However, it is important to keep in mind that this should be done with appropriately selected patients and third-degree cancer centers, following a well-defined management strategy.

Featured: Sigrid Carlsson, MD, Ph.D., MPH, Epidemiologist Attending, Memorial Sloan Kettering Cancer Center

Written By: Hanan Goldberg, MD, Urology Oncology Man, SUO, University of Toronto, Princess Margaret Cancer Center, @GoldbergHanan, 19th Annual Meeting of the Urological Oncology Association (SUO), 28-30 November 2018 – Phoenix, Arizona

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