National Comprehensive Cancer Network® Favorable Intermediate Risk Prostate Cancer-Is Active Surveillance...

Area of Science:

• Urology
• Oncology
• Pathology

Background:

• Active surveillance is a management option for low-risk prostate cancer.
• Favorable intermediate-risk prostate cancer patients may also be candidates for active surveillance.
• Current guidelines (National Comprehensive Cancer Network® [NCCN]®) define criteria for active surveillance eligibility.

Purpose of the Study:

• To compare pathological and biochemical outcomes of radical prostatectomy in favorable intermediate-risk patients meeting NCCN active surveillance criteria versus those meeting traditional criteria.
• To evaluate the risk of adverse pathological findings and biochemical recurrence in different risk groups.

Main Methods:

• Retrospective analysis of 3,686 patients undergoing radical prostatectomy (2014-2015).
• Patients categorized into low, favorable intermediate, and unfavorable intermediate risk groups based on NCCN criteria and specific clinical factors.
• Comparison of adverse pathological findings (Gleason Grade Group 3-5, nonorgan-confined disease, nodal involvement) and time to biochemical recurrence using Cox regression.

Main Results:

• 250 patients were classified as favorable intermediate risk.
• Favorable intermediate-risk patients had a significantly higher rate of adverse pathological findings (27.4%) compared to low-risk patients (14.8%, p <0.001).
• Time to biochemical recurrence differed significantly across risk groups (p <0.001).

Conclusions:

• Favorable intermediate-risk prostate cancer patients represent a distinct group compared to low-risk patients.
• Active surveillance selection and monitoring require careful consideration for favorable intermediate-risk patients.
• These findings highlight the need for tailored management strategies within active surveillance programs.