Active surveillance should be considered for select men with Grade Group 2 prostate cancer Review
| Authors: | Pekala, K. R.; Bergengren, O.; Eastham, J. A.; Carlsson, S. V. |
| Review Title: | Active surveillance should be considered for select men with Grade Group 2 prostate cancer |
| Abstract: | Background: Treatment decisions for localized prostate cancer must balance patient preferences, oncologic risk, and preservation of sexual, urinary and bowel function. While Active Surveillance (AS) is the recommended option for men with Grade Group 1 (Gleason Score 3 + 3 = 6) prostate cancer without other intermediate-risk features, men with Grade Group 2 (Gleason Score 3 + 4 = 7) are typically recommended active treatment. For select patients, AS can be a possible initial management strategy for men with Grade Group 2. Herein, we review current urology guidelines and the urologic literature regarding recommendations and evidence for AS for this patient group. Main body: AS benefits men with prostate cancer by maintaining their current quality of life and avoiding treatment side effects. AS protocols with close follow up always allow for an option to change course and pursue curative treatment. All the major guideline organizations now include Grade Group 2 disease with slightly differing definitions of eligibility based on risk using prostate-specific antigen (PSA) level, Gleason score, clinical stage, and other factors. Selected men with Grade Group 2 on AS have similar rates of deferred treatment and metastasis to men with Grade Group 1 on AS. There is a growing body of evidence from randomized controlled trials, large observational (prospective and retrospective) cohorts that confirm the oncologic safety of AS for these men. While some men will inevitably conclude AS at some point due to clinical reclassification with biopsy or imaging, some men may be able to stay on AS until transition to watchful waiting (WW). Magnetic resonance imaging is an important tool to confirm AS eligibility, to monitor progression and guide prostate biopsy. Conclusion: AS is a viable initial management option for well-informed and select men with Grade Group 2 prostate cancer, low volume of pattern 4, and no other adverse clinicopathologic findings following a well-defined monitoring protocol. In the modern era of AS, urologists have tools at their disposal to better stage patients at initial diagnosis, risk stratify patients, and gain information on the biologic potential of a patient’s prostate cancer. © 2023, BioMed Central Ltd., part of Springer Nature. |
| Keywords: | retrospective studies; clinical feature; histopathology; drug safety; patient selection; note; cancer patient; cancer staging; nuclear magnetic resonance imaging; follow up; cancer grading; prospective study; prospective studies; prostate specific antigen; quality of life; clinical protocol; patient monitoring; practice guideline; pathology; retrospective study; risk assessment; prostate cancer; gleason score; prostate-specific antigen; prostatic neoplasms; active surveillance; watchful waiting; prostate tumor; prostate biopsy; cancer size; patient safety; medical literature; cancer classification; procedures; neoplasm grading; humans; human; male; grade group 2 |
| Journal Title: | BMC Urology |
| Volume: | 23 |
| ISSN: | 1471-2490 |
| Publisher: | Biomed Central Ltd |
| Date Published: | 2023-09-30 |
| Start Page: | 152 |
| Language: | English |
| DOI: | 10.1186/s12894-023-01314-6 |
| PUBMED: | 37777716 |
| PROVIDER: | scopus |
| PMCID: | PMC10541702 |
| DOI/URL: | |
| Notes: | The MSK Cancer Center Support Grant (P30 CA008748) is acknowledged in the PDF -- Corresponding author is MSK author: Sigrid V. Carlsson -- Source: Scopus |
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