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Prostate cancer mortality and metastasis under different biopsy frequencies in North American active surveillance cohorts
- Source :
- Cancer. 126(3)
- Publication Year :
- 2019
-
Abstract
- Background Active surveillance (AS) is an accepted means of managing low-risk prostate cancer. Because of the rarity of downstream events, data from existing AS cohorts cannot yet address how differences in surveillance intensity affect metastasis and mortality. This study projected the comparative benefits of different AS schedules in men diagnosed with prostate cancer who had Gleason score (GS) ≤6 disease and risk profiles similar to those in North American AS cohorts. Methods Times of GS upgrading were simulated based on AS data from the University of Toronto, Johns Hopkins University, the University of California at San Francisco, and the Canary Pass Active Surveillance Cohort. Times to metastasis and prostate cancer death, informed by models from the Scandinavian Prostate Cancer Group 4 trial, were projected under biopsy surveillance schedules ranging from watchful waiting to annual biopsies. Outcomes included the risk of metastasis, the risk of death, remaining life-years (LYs), and quality-adjusted LYs. Results Compared with watchful waiting, AS biopsies reduced the risk of prostate cancer metastasis and prostate cancer death at 20 years by 1.4% to 3.3% and 1.0% to 2.4%, respectively; and 5-year biopsies reduced the risk of metastasis and prostate cancer death by 1.0% to 2.4% and 0.6% to 1.6%, respectively. There was little difference between annual and 5-year biopsy schedules in terms of LYs (range of differences, 0.04-0.16 LYs) and quality-adjusted LYs (range of differences, -0.02 to 0.09 quality-adjusted LYs). Conclusions Among men diagnosed with GS ≤6 prostate cancer, obtaining a biopsy every 3 or 4 years appears to be an acceptable alternative to more frequent biopsies. Reducing surveillance intensity for those who have a low risk of progression reduces the number of biopsies while preserving the benefit of more frequent schedules.
- Subjects :
- Oncology
Male
Cancer Research
medicine.medical_specialty
medicine.medical_treatment
Biopsy
Disease
Risk Assessment
White People
Metastasis
Cohort Studies
03 medical and health sciences
Prostate cancer
0302 clinical medicine
Internal medicine
medicine
Humans
030212 general & internal medicine
Neoplasm Metastasis
Aged
Aged, 80 and over
medicine.diagnostic_test
business.industry
Prostate
Prostate cancer mortality
Prostatic Neoplasms
Middle Aged
Prostate-Specific Antigen
medicine.disease
United States
030220 oncology & carcinogenesis
Cohort
North America
Disease Progression
San Francisco
Risk of death
Quality-Adjusted Life Years
Neoplasm Grading
business
Watchful waiting
Subjects
Details
- ISSN :
- 10970142
- Volume :
- 126
- Issue :
- 3
- Database :
- OpenAIRE
- Journal :
- Cancer
- Accession number :
- edsair.doi.dedup.....8828067d42e6c5daed2a6c18172dfa26