Oral Presentation Clinical Oncology Society of Australia Annual Scientific Meeting 2019

Active Surveillance (AS) for low and intermediate risk prostate cancer (PCa): Patterns of care from the NSW Prostate Clinical Cancer Registry (PCCR). (#73)

Chau Bui 1 , Andrew Brooks 2 , Claire Cooke-Yarborough 1 , Warick Delprado 3 4 5 , Andrew Kneebone 6 , Manish Patel 5 6 7 , David Smith 8 , Serina Teuss 9
  1. NSW Cancer Registry, Cancer Institute NSW, Sydney, NSW, Australia
  2. Sydney West Local Area Health Network, Sydney, NSW, Australia
  3. Douglass Hanly Moir Pathology, Sydney, NSW, Australia
  4. University of Notre Dame, Sydney, NSW, Australia
  5. Macquarie University Hospital, Sydney, NSW, Australia
  6. University of Sydney, Sydney, NSW, Australia
  7. Westmead Private Hospital, Sydney, NSW, Australia
  8. Cancer Council NSW, Sydney, NSW, Australia
  9. NSW Prostate Clinical Cancer Registry, Sydney, NSW, Australia

Introduction: AS is an established management option for low-risk (LR) PCa and is increasing in intermediate-risk (IR) men although data on outcomes is limited1,2. Our data reports on patterns of care for LR and IR PCa in NSW.

Methods: Data were obtained for 4833 men participating in the PCCR diagnosed with localised PCa by biopsy, from 2015-2018. Participation by specialists and hospitals is voluntary. Primary treatments are recorded for all participants and follow-up data collected where available. The D'Amico classification (cT-stage omitted due to incomplete data) was used to classify LR and IR groups. IR with grade group (GG) 1-2 were sub-classified as favourable-IR and those with GG 3 as unfavourable-IR. Advanced pathology (AP) was defined as an upgrade of GG or stage (extraprostatic disease).

Results: Overall, 3343 cases were classified as either LR or IR. Of 942 LR men, 735 (78.0%) were primarily managed by AS and 140 (14.9%) by radical prostatectomy (RP). Of those managed by AS, 86 (11.7%) progressed to active treatment within 2 years. For those whose primary treatment was RP, 104 (74.3%) had AP. Of 1567 favourable-IR men, 890 (56.8%) had a primary RP - 466 (52.4%) of these cases had AP. Of the 279 (17.8%) managed by AS, 47 (16.8%) progressed to active treatment. Of the 834 unfavourable-IR men, 518 (62.1%) were primarily managed by RP - 323 (62.4%) of these cases had AP. Of the 37 (4.4%) managed by AS, 3 (8.1%) progressed to active treatment.

Conclusion: Overall most LR men were managed by AS. The proportion of AS cases progressing to intervention is low in both LR and favourable-IR groups and negligible for unfavourable-IR men. Where the primary treatment was RP, AP was seen in the prostate specimen in the majority of LR men and half of the favourable-IR men.

  1. Loeb S, Folkvaljon Y, Bratt O, Robinson D, Stattin P, Defining Intermediate Risk Prostate Cancer Suitable for Active Surveillance. J Urol 2019; 201(2):292-299.
  2. Butler SS, Mahal BA, Lamba N, Mossanen M, Martin NE, Mouw KW, Nguyen PL, Muralidhar V, Use and early mortality outcomes of active surveillance in patients with intermediate-risk prostate cancer. Cancer 2019; doi:10.1002/cncr.32202.