Active surveillance for intermediate-risk prostate cancer: a systematic review and pooled analysis.
Alessandro Uleri, Ludovica Cella, Thibaut Long-Depaquit et al.
✦ AI-curated · Sources linked
In 30 seconds
This systematic review and meta-analysis assessed active surveillance (AS) outcomes in selected patients with intermediate-risk prostate cancer, including Gleason Grade Groups 1–2. Across 18 studies and 3783 patients, pooled AS discontinuation-free survival was 63% (95% CI 58-68) at 5 years. Grade Group ≥3 upgrade-free survival was 84% (95% CI 76-92) at 3 years and 78% (95% CI 65-91) at 5 years. The authors conclude that AS appears oncologically safe for well-selected patients, while noting limited long-term evidence.
Key findings
- Pooled AS discontinuation-free survival was 70% (95% CI 62-78) at 3 years, 63% (95% CI 58-68) at 5 years, and 53% (95% CI 38-67) at 10 years.
- Grade Group ≥3 upgrade-free survival was 84% (95% CI 76-92) at 3 years and 78% (95% CI 65-91) at 5 years across cohorts.
- In cohorts screened with multiparametric MRI, Grade Group ≥3 upgrade-free survival was 92% (95% CI 86-98) at 3 years and 87% (95% CI 78-95) at 5 years.
- AS discontinuation did not differ significantly between biopsy Grade Groups 1 and 2 (hazard ratio 1.08; 95% CI 0.86-1.35).
Why it matters
The pooled results provide estimates of surveillance persistence and grade upgrading in selected patients with intermediate-risk disease, an area with less established evidence than low-risk prostate cancer. They may help frame discussions about surveillance eligibility and follow-up, while the limited long-term oncological data mean these estimates should be interpreted cautiously.
What to keep in mind
The review reports moderate risk of bias and heterogeneity across AS protocols. Long-term data, particularly on robust oncological outcomes, are lacking.