July 31, 2018
Younger patients with prostate cancer who have a lower risk of Gleason score upgrading and biopsy progression may also be good candidates for active surveillance (AS), according to a study published in Urology.1
AS is commonly used among patients with low-risk prostate cancer, as it may prevent adverse events (eg, erectile dysfunction, urinary incontinence) caused by definitive therapies, but despite strict eligibility criteria, has been associated with higher rates of histological progression. AS use among in younger patients remains controversial; the effect of age on outcomes in AS is not well-reported and requires further study.
For this systematic review, the authors evaluated the outcomes of 8 studies encompassing 6544 patients with prostate cancer on AS. Because prior studies have varying primary outcomes, the authors performed subgroup analyses using biopsy progression (Gleason score upgrading and/or tumor volume increases at follow-up) or Gleason score upgrading as study outcomes. The estimated median age was 65.8 years.
Results showed that patients have a 13% to 17% lower risk of Gleason score upgrading per decade of decreasing age (odds ratio [OR], 0.83; 95% CI, 0.73-0.94; P = .004 ...