Risk of Metastasis in Men with Grade Group 2 Prostate Cancer Managed with Active Surveillance at a Tertiary Cancer Center| Journal of Urology

Adult Urology | Journal of Urology




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Risk of Metastasis in Men with Grade Group 2 Prostate Cancer Managed with Active Surveillance at a Tertiary Cancer Center

Karim Touijer
2-3 minutes




Abstract


Purpose:

To study the risk of metastatic prostate cancer development in men with Grade Group
2 disease being managed with active surveillance (AS) at Memorial Sloan Kettering
Cancer Center.




Materials and Methods:

219 men with Grade Group 2 prostate cancer were managed with AS between 2000–2017.
Biopsy was performed every 2–3 years or upon changes in magnetic resonance imaging,
prostate-specific antigen (PSA) level, or digital rectal examination. The primary
outcome was development of distant metastasis. The Kaplan-Meier method was used to
estimate treatment-free survival.




Results:

The median age at diagnosis was 67 years (IQR 61–72), the median PSA was 5 ng/mL (IQR
4–7), and most patients (69%) had non-palpable disease. During follow-up, 64 men received
treatment: 36/64 (56%) radical prostatectomy; 20/64 (31%) radiotherapy; 3/64 (5%)
hormone therapy; and 5/64 (8%) focal therapy. Of the 36 patients who underwent radical
prostatectomy, 32/36 (89%) had Grade Group 2 disease on pathology and 4/36 (11%) had
Grade Group 3. Treatment-free survival was 61% (95% CI 52%–70%) at 5 years and 49%
(95% CI 37%–60%) at 10 years. Three men experienced biochemical recurrence, no men
developed distant metastasis, and no men died of prostate cancer during the follow-up.
The median follow-up was 3.1 years (IQR 1.9–4.9).




Conclusions:

AS appears to be a safe initial management strategy in the short term for carefully
selected and closely monitored men with Grade Group 2 prostate cancer managed at a
tertiary cancer center. Definitive conclusions await further follow-up.



© 2020 by American Urological Association Education and Research, Inc.

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