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Evidence for active surveillance approach to managing intermediate-risk prostate cancer

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Active surveillance (AS) is supported as an initial option for men with low-risk prostate cancer (PC) and a minimum life expectancy of 10 years. According to results of a new study from Brigham and Women’s Hospital (MA, USA), there is also evidence to support AS as an initial approach for men with favorable intermediate risk of PC.

“We found that men with favorable intermediate risk PC did not have significantly increased risks of death compared to men with low-risk PC,” explained the study’s first author Ann Caroline Raldow (Brigham and Women’s Hospital and the Harvard Radiation Oncology Program [MA, USA]). “The clinical significance of our findings is that men with favorable intermediate-risk PC may also be able to avoid, or at least defer the side effects of, PC treatment, and enter an AS program as an initial approach.”

Risk of PC-specific mortality (PCSM) and all-cause mortality (ACM) following brachytherapy were compared in a prospective cohort study of 5580 men. The researchers observed that men with favorable intermediate risk did not have significantly increased risk of PCSM and ACM in comparison with low-risk PC after a median follow-up of 7.69 years. In addition, absolute estimates of PCSM were less than 1% in men with low-risk and favorable intermediate-risk PC, suggesting that men with favorable intermediate-risk PC may also be appropriate AS candidates.

To date, no direct comparison of PCSM or ACM following brachytherapy in favorable intermediate- and low-risk PC has been made. The researchers are continuing their work into AS as an initial approach for men with favorable intermediate risk PC and are awaiting results of a randomized trial comparing AS with treatment.

Written by Hannah Wilson

Sources: Raldow AC, Zhang D, Chen MH, Braccioforte MH, Moran BJ, D’Amico AV. Risk Group and Death From Prostate Cancer: Implications for Active Surveillance in Men With Favorable Intermediate-Risk Prostate Cancer. JAMA Oncol. doi:10.1001/jamaoncol.2014.284 (2015) (Epub ahead of print); Brigham and Women’s Hospital press release: www.brighamandwomens.org/about_bwh/publicaffairs/news/pressreleases/Pres…

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