Pacific D
Prostate Cancer Mortality and Metastasis under Different Biopsy Frequencies in North American Active Surveillance Cohorts (307850)
Ruth Etzioni, Fred Hutchinson Cancer Research Center*Jane Lange, Fred Hutchinson Cancer Research Center
Keywords: Prostate cancer, modeling, active surveillance, simulation
Active surveillance (AS) is an accepted means of managing low-risk prostate cancer. Due to rarity of downstream events, data from existing AS cohorts cannot yet address how differences in surveillance intensity affect metastasis and mortality. This study uses a simulation approach to project the comparative benefits of different AS schedules in men diagnosed with Gleason Score (GS) 6 or below with risk profiles similar to those in North American AS cohorts. Compared to watchful waiting, annual surveillance biopsies reduced the risk of prostate cancer metastasis (death) at 20 years by 1.4-3.3% (death 1.0-2.4%) and 5 year biopsies by 1.0-2.4% (death .6-1.6%). There was little difference between annual and five year biopsy schedules in terms of life years (range of differences 0.04-0.16), and quality-adjusted life years (range -0.09-0.02). In conclusion, in men diagnosed with GS< 6, biopsying every 3-4 years appears is an acceptable alternative to more frequent biopsies. Reducing surveillance intensity for those with low risk of progression reduces the number of biopsies while preserving the benefit of more frequent schedules.