Long-term outcomes of active surveillance for clinically localized prostate cancer in a community-based setting: results from a prospective non-interventional study - Scorecard - MDSpire
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Long-term outcomes of active surveillance for clinically localized prostate cancer in a community-based setting: results from a prospective non-interventional study
Clinical Scorecard: Long-term Effects of Active Surveillance on Clinically Localized Prostate Cancer in a Community Setting: Findings from a Prospective Non-Interventional Study
At a Glance
Category
Detail
Condition
Clinically localized prostate cancer (PCa)
Key Mechanisms
Active surveillance (AS) involves regular PSA assessment, digital rectal examination (DRE), and re-biopsies to monitor disease progression and switch to invasive treatment if needed
Target Population
Patients with well-differentiated, localized prostate cancer (T-category ≤ cT2c, PSA ≤ 10 ng/ml, Gleason grade group 1, PSA-density ≤ 0.2 ng/ml2, ≤ 2 positive biopsies)
Care Setting
Community setting, primarily office-based urologists
Key Highlights
10-year cancer-specific survival with AS exceeds 98%, comparable to immediate invasive treatment
In a community setting, 56.8% of patients discontinued AS for invasive treatment over median 7.7 years follow-up
10-year overall survival was 86% and metastasis-free survival was 97% in the AS cohort
Baseline assessment includes PSA, DRE, and prostate biopsy
Management
Follow-up with PSA, DRE, and PSA doubling time every 3 months for first 2 years, then every 6 months
Re-biopsy recommended after 1 year and every 3 years thereafter
Discontinue AS upon histological progression, PSA-DT < 3 years, clinical progression on DRE, or patient preference
Monitoring & Follow-up
Regular PSA testing and DRE to detect progression
Repeat biopsies to assess histological changes
Monitor PSA doubling time as a marker of progression
Risks
Risk of progression requiring invasive treatment exists; 56.8% discontinued AS in this study
Small risk of metastasis (2.1% developed metastasis over median 7.7 years)
Potential for patient drop-out or loss to follow-up (20.7% in this study)
Patient & Prescribing Data
329 patients with localized prostate cancer under AS in a community setting
Over median 7.7 years, 56.8% discontinued AS for invasive treatments (radical prostatectomy, radiotherapy, hormone therapy); main reasons included biopsy upgrade and PSA elevation
Clinical Best Practices
Strict adherence to inclusion criteria for AS to select appropriate candidates
Implement structured follow-up protocols with frequent PSA, DRE, and scheduled re-biopsies
Promptly discontinue AS upon evidence of progression or patient preference
Engage patients in shared decision-making and ensure close monitoring to minimize loss to follow-up
Recognize that AS in community settings can achieve outcomes comparable to academic centers
