Active surveillance can yield excellent results in carefully selected younger men with prostate cancer, according to a new study. A second study also finds that the use of telemedicine to evaluate prostate cancer is a viable option in certain cases, including as part of active surveillance of the malignancy.
“We have made significant progress in the way that we screen and manage prostate cancer, and these advances will help the next generation of patients and physicians,” said Stacy Loeb, MD, of New York University, in a press release from the American Urological Association (AUA). Both new studies will be presented at the AUA’s Annual Meeting in Boston, taking place May 12–16.
In the first study, researchers led by Keyan Salari, MD, PhD, of Massachusetts General Hospital and Harvard Medical School in Boston, explored outcomes of active surveillance in men under the age of 60; previous work has not included many patients in this age group. In total, they analyzed outcomes of 432 men treated with active surveillance with a median age at diagnosis of 55 years from databases at Salari’s institution and at the Sunnybrook Health Sciences Centre in Toronto.
Over a median follow-up of 5.1 years, 84.3% of patients underwent a repeat biopsy, and 62.6% of those showed prostate cancer: 24.5% were benign, 7.7% showed prostatic intraepithelial neoplasia, and 5.2% showed atypia. The actuarial freedom-from-treatment rate at 5 years was 74.3%, and at 10 years it was 55.4%.
A total of 131 patients (30.3%) progressed to treatment, mostly for progression (64.1%); other reasons included prostate-specific antigen (PSA) progression (18.3%), patient preference (11.5%), volume progression (3.1%), and other reasons (3.1%). Five patients developed metastasis over the study period, two with positive lymph nodes at the time of radical prostatectomy and three with distant metastasis. The metastasis-free survival rate was 99.7% at 5 years and 97.5% at 10 years, and there were no prostate cancer–specific deaths.
In another study to be presented at the AUA meeting, researchers led by Deborah T. Glassman, MD, of Jefferson University in Philadelphia, evaluated patient satisfaction with telemedicine at various stages of prostate cancer management. They performed a retrospective analysis of 424 consecutive telemedicine encounters, and 219 patients (52% response rate) completed a satisfaction survey.
Thirty of the encounters involved prostate cancer as the primary diagnosis; 16 encounters included discussion of prostate biopsy results, and other reasons included prostatectomy follow-up, metastatic cancer follow-up, PSA follow-up (which was part of active surveillance protocol), and discussion of a positive bone scan result. All types of encounters resulted in high patient satisfaction scores, with no differences between the types of encounter.
“Our results suggest that video visits can satisfactorily be carried out in the management of prostate cancer, particularly with patients undergoing active surveillance,” the authors concluded in an abstract.