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A New Technique for Treating Low-risk Prostate Cancer—Super Active Surveillance
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Surveillance Versus Treatment for Favorable Intermediate-Risk Prostate Cancer and Mortality-Risk.

Mutlay Sayan1, Yetkin Tuac2, Zhiyu Qian3,4

  • 1Department of Radiation Oncology, Brigham and Women's Hospital and Dana Farber Cancer Institute, Boston, Massachusetts, USA.

The Prostate
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Summary

Younger men with favorable-intermediate-risk prostate cancer (PC) had similar low mortality risks whether managed with active surveillance (AS) or immediate treatment. Race did not significantly alter these outcomes in this study.

Keywords:
active surveillanceprostatectomyprostatic neoplasmsradiotherapywatchful waiting

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Area of Science:

  • Oncology
  • Urology
  • Public Health

Background:

  • Active surveillance (AS) is standard for low-risk prostate cancer (PC).
  • The mortality risk for younger patients (<60 years) with favorable-intermediate-risk (FIR) PC on AS is not well-established.
  • This study investigates mortality differences between AS and immediate treatment in younger FIR PC patients, stratified by race.

Purpose of the Study:

  • To evaluate all-cause, PC-specific, and non-PC-specific mortality in younger patients (<60 years) with FIR PC.
  • To compare outcomes between AS/watchful-waiting (WW) and immediate definitive treatment (radical prostatectomy/radiotherapy).
  • To explore the impact of race (White vs. underrepresented minority [URM]) on these mortality risks.

Main Methods:

  • Retrospective cohort study using SEER data from 2010-2020.
  • Included patients were <60 years old with FIR PC.
  • Multivariable Cox and Fine-Gray competing-risk regressions were used, with statistical significance set at p<0.025.

Main Results:

  • Among 3,832 patients, 127 died (3.31%), with 18 PC-specific deaths (14.17%).
  • Immediate treatment (RP/RT) did not significantly reduce all-cause or non-PC-specific mortality compared to AS/WW in either White or URM patients.
  • RP/RT significantly reduced PC-specific mortality in URM patients (AHR 0.03) but not White patients (AHR 0.21).

Conclusions:

  • Early mortality risks were low and similar for younger patients (<60 years) with FIR PC, regardless of management (AS/WW vs. RP/RT) or race.
  • While immediate treatment showed a trend toward reduced PC-specific mortality in White patients, it was significant only in URM patients.
  • Findings suggest AS is a viable option for carefully selected younger FIR PC patients.