Long-Term PCa Outcomes Worse With AS

Investigators find increased 10-year

PROSTATE CANCER-specific survival at 10 years is slightly lower among men with low-grade disease undergoing active surveillance (AS) compared with definitive initial treatment, according to population-based data.

“Although outcomes on AS are excellent, these results do suggest that some men are misclassified or may miss an opportunity for cure,” Antonio Finelli, MD, of the Princess Margaret Cancer Centre at the University of Toronto in Canada and colleagues wrote in The Journal of Urology.

In the retrospective study, investigators compared long-term cancer outcomes among 21,282 men with Grade Group 1 cancer receiving AS or definitive initial treatment with radiation or surgery in Ontario, Canada from 2002 to 2014. At 10 years, only 39% of men remained on AS, the investigators reported. The 10-year prostate cancer-specific survival rates were 98.1% with AS and 99.1% in the initial treatment group. The 10-year metastasis-free survival rates were 94.2% and 95.8%, respectively, and the

Cardiac Risks Higher in Men With Priapism

PRIAPISM IS associated with an increased risk for cardiovascular and cerebrovascular events in the years following an episode of the condition, investigators reported in The Journal of Urology.

In a study that included 10,459 men with priapism (mean age 51.1 years), a team led by Michael L. Eisenberg, MD, of Stanford University School of Medicine in Palo Alto, California, found that these men had a 24% increased risk for both ischemic and other heart disease and 33% increased risk for cerebrovascular disease in the years following a priapism diagnosis compared with a matched group of men with other sexual dysfunctions.

The rate of cardiovascular disease and thromboembolic events was higher among men with more priapism episodes. ■

Risks Compared With Initial Definitive Treatment

10-year overall survival rates were 88.7% and 89.9%, respectively.

In a landmark analysis, AS was significantly associated with a 66% increased risk of prostate cancer-specific mortality, 34% increased risk of metastasis, and 12% increased risk of all-cause mortality compared with initial treatment, Dr Finelli’s team reported. In a propensity-score matched analysis, AS was significantly associated with a 28%, 12%, and 87% increased risks of these outcomes, respectively, compared with initial treatment.

The investigators calculated that 125 men on AS would need to receive initial treatment to prevent 1 prostate cancer death at 10 years. They cautioned that overtreatment is associated with potential urinary, bowel, and sexual-related harms.

The findings highlight “a need for a careful discussion between patient and clinician to balance treatment-related side effects and impact on quality of life vs the modest decrease in PC-specific mortality associated with intervention,” Dr Finelli’s team wrote.

vs Treatment: Long-Term

Men on active surveillance (AS) for low-grade prostate cancer had lower rates of 10-year prostate cancer-specific, metastatis-free, and overall survival compared with patient who had definitive initial treatment.

Study strengths included the size of the cohort, length of follow-up, and use of population-based outcomes within the context of universal health care, according to Dr Finelli’s team. Further, unlike in many prior published studies, they distinguished AS from watchful waiting, which are dissimilar approaches that result in different oncologic outcomes, they noted.

They also acknowledged study limitations. For example, they inferred AS if there was no definitive treatment claim. In addition, data on prostate cancer stage and PSA levels were incomplete, and most men were diagnosed before widespread use of pre-biopsy prostate magnetic resonance imaging, according to the investigators. ■