Active Surveillance Risky for Intermediate-Risk Prostate Cancer

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Some treatment guidelines suggest that active surveillance may be an option for certain men with intermediate-risk prostate cancer, although the practice is controversial.

To provide clarification, researchers analyzed data from more than 6,700 men who had undergone a radical prostatectomy. They categorized a man as having low-volume intermediate risk (LVIR) if his prostate biopsy yielded only one or two needle samples (or “cores”) that had malignant cells, his Gleason score was 3 + 4 = 7, and his prostate-specific antigen (PSA) level was below 20 ng/mL. Based on their results for the same criteria, other men were categorized as very low risk (VLR) or low risk (LR).

Pathology studies of theprostate tissue removed during surgery found that many men in the LVIR group-nearly one in four-had aggressive cancer. In fact, men in this group were 4.5 to 5 times more likely than men in the VLR and LR groups to have tumors that required immediate treatment.The findings were published online on July 13, 2017 in JAMA Oncology.

This study and others do not support the idea that there is a “favorable” subgroup among intermediate-risk patients who would benefit from active surveillance. Fortunately, prompt treatment can offer a cure to men in this group.