Prostate Cancer Recurrence Risk Higher During Active Surveillance Era – Renal and Urology News

Biochemical recurrence (BCR) of prostate cancer after radical prostatectomy increased in the active surveillance (AS) era, driven by a higher-risk case mix and increased BCR risk among high-risk patients, according to recent study findings.

Investigators led by Timothy J. Daskivich, MD, MSHPM, of Cedars-Sinai Medical Center in Los Angeles, California, sampled 6682 patients who underwent radical prostatectomy for clinically localized tumors from 2000 to 2017, with 3492 (52%) and 3190 (48%) having surgery before and after 2010 (pre-AS and AS eras, respectively).

“BCR risk has increased in the AS era, with 40% of men experiencing BCR at 8-years after RP, an increase from the traditionally quoted 33% at 10-years from historical reference,” Dr Daskivich’s team reported in Urologic Oncology.

BCR risk was a significant 15% higher in the AS era compared with before, but this effect was eliminated after correcting for tumor risk, “suggesting that differences in tumor risk between eras mediated the change.”

Compared with the pre-AS era, BCR risk among patients with favorable and unfavorable intermediate-risk prostate cancer was a significant 24% and 22% lower in the AS era, but was a significant 22% higher among patients with high-risk prostate cancer, the investigators reported.

The 8-year risks of BCR in the post-2010 era were 21%, 25%, 41%, and 60% for low-, favorable intermediate-, unfavorable intermediate-, and high-risk disease, respectively.

“It is imperative to clearly communicate these contemporary risks of BCR to patients so that they can most accurately understand the outcomes with definitive treatment and can therefore make better-informed shared decisions regarding treatment options,” the investigators concluded.