The following is a summary of “Conditional survival of patients with low-risk prostate cancer: Temporal changes in active surveillance permanence over time,” published in the July 2023 issue of the Urologic Oncology by Francesco et al.

The objective of this study is to determine risk categories for patients with prostate cancer (PCa) in active surveillance (AS) and to evaluate the conditional survival (CS) model that examined the effect of event-free survival since AS entry. From January 2012 to December 2020, 606 PCa patients enrolled in their AS program were analyzed. Kaplan-Meier (KM) plots illustrated the AS-exit rate. 

Multivariable Cox regression models (MCRMs) were evaluated for independent AS-exit rate predictors to determine risk categories. After stratification according to risk categories and event-free survival intervals of 1, 2, 3, and 5 years, the aggregate AS exit rate was calculated using CS estimates. PSAd 0.15 (HR: 1.43; P=0.04), PI-RADS 4-5 (HR: 2.56; P=0.001), and several biopsy-positive samples ≥2 (HR: 1.75; P=0.001) were independent predictors of AS-exit at MCRMs. These variables were utilized to determine low-, intermediate-, and high-risk categories. By CS analyses, the 5-year AS-exit-free rate increased from 59.7% at baseline to 67.3%, 74.3%, and 89.4% in patients who remained in AS for ≥1, ≥2, ≥3, and ≥5 years, respectively. 

After stratification according to risk categories, ≥5-year AS-exit-free rates increased from 76.3% to 100% in low-risk patients, 62.7% to 83.3% in intermediate-risk patients, and 42.3% to 87.5% in high-risk patients. CS models revealed a direct correlation between event-free survival duration and subsequent AS permanence in patients with PCa regardless of risk stratification.

Source: sciencedirect.com/science/article/abs/pii/S1078143923000911