Long-term data on active surveillance from MSKCC

A presentation at the upcoming annual meeting of the American Urological Association (AUA) will provide data on outcomes of men initially managed on active surveillance at Memorial Sloan-Kettering Cancer Center (MSKCC) in New York over the past 17 years.

The presentation by Carlsson et al. encompasses data from > 3,000 patients initially enrolled and managed on active surveillance between 2000 and 2017. All patients were recommended to have a confirmatory biopsy to confirm eligibility for active surveillance. MRI studies have been increasingly utilized in more recent years. Patients were reassessed every 6 months with digital rectal examinations (DREs), measurement of PSA levels, and a review of general health and symptoms. Repeat biopsies were usually gieven every 2 to 3 years or as suggested by changes in MRI, DRE, and/or PSA data. Treatment — or recommendations for treatment — could be triggered by patient preference or by disease progression.

Here is a summary of the study data:

  • 3,009 patients were initially monitored on active surveillance.
    • 91 percent were classified as having Grade Group 1 disease.
    • 7.7 percent were classified as having Grade Group 2 disease.
    • 0.7 percent were classified as having Grade Group 3 disease.
  • The average (median) follow-up is 4.2 years for those without metastasis.
  • The average (median) age at diagnosis was 63 years (with a trend towards a lower age at diagnosis in more recent years).
  • Treatment-free survival is
    • 74 percent at 5 years after the start of active surveillance
    • 62 percent at 10 years after the start of active surveillance
    • 56 percent at 15 years after the start of active surveillance
  • Risk for progression (from Grade Group 1 to 2 or 3) is
    • 24 percent at 5 years
    • 36 percent at 10 years
    • 43 percent at 15 years
  • Two patients have died from their prostate cancer over the 17 years of the study.
  • Actuarial estimates of survival data at 10 years are
    • Metastasis-free survival = 98 percent
    • Cancer- specific survival = 100 percent
    • Overall survival = 92 percent

These data once again confirm the potential for high quality of long-term outcomes for men on active surveillance over time. However, …

The “New” Prostate Cancer InfoLink also wants to re-emphasize that all the active surveillance cohorts that have shown such high-quality, long-term outcomes have been based on rigorous and carefully conducted active surveillance protocols, with patients receiving regular re-assessments and repeat biopises and/or MRI scans as necessary to maximize awareness of possible signals of disease progression. This is “real” active surveillance. It isn’t just a mildly more attentive form of watchful waiting. It is particularly important for support group leaders and other prostate cancer educators to be aware of the rigor of the surveillance appropriate for high-quality active surveillance

2 Responses

  1. “It isn’t just a mildly more attentive form of watchful waiting.”

    So few words to say so much.

  2. I find it interesting that the 15-year treatment-free survival was 56% at MSKCC and 55% at Sunnybrook — nearly identical. Johns Hopkins (JH), using tighter entrance criteria and more stringent triggers for intervention, reported 43% had avoided curative treatment at 15 years. 15-year metstasis-free survival was 98%, 97%, and 99% at MSKCC, Sunnybrook, and JH, respectively. This suggests to me that there is little to be lost and much to be gained by following less restrictive entrance and intervention criteria. Better diagnostic methods (like mpMRI-targeted biopsy or template-mapping biopsy) may be able to mitigate any small increase in risk.

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