Prostate cancer mortality and metastasis under different biopsy frequencies in North American active surveillance cohorts

Jane M. Lange, Aaron A. Laviana, David F. Penson, Daniel W. Lin, Anna Bill-Axelson, Sigrid V. Carlsson, Lisa F. Newcomb, Bruce J. Trock, H. Ballentine Carter, Peter R. Carroll, Mathew R. Cooperberg, Janet E. Cowan, Laurence H. Klotz, Ruth B. Etzioni

Research output: Contribution to journalArticle

Abstract

Background: Active surveillance (AS) is an accepted means of managing low-risk prostate cancer. Because of the rarity of downstream events, data from existing AS cohorts cannot yet address how differences in surveillance intensity affect metastasis and mortality. This study projected the comparative benefits of different AS schedules in men diagnosed with prostate cancer who had Gleason score (GS) ≤6 disease and risk profiles similar to those in North American AS cohorts. Methods: Times of GS upgrading were simulated based on AS data from the University of Toronto, Johns Hopkins University, the University of California at San Francisco, and the Canary Pass Active Surveillance Cohort. Times to metastasis and prostate cancer death, informed by models from the Scandinavian Prostate Cancer Group 4 trial, were projected under biopsy surveillance schedules ranging from watchful waiting to annual biopsies. Outcomes included the risk of metastasis, the risk of death, remaining life-years (LYs), and quality-adjusted LYs. Results: Compared with watchful waiting, AS biopsies reduced the risk of prostate cancer metastasis and prostate cancer death at 20 years by 1.4% to 3.3% and 1.0% to 2.4%, respectively; and 5-year biopsies reduced the risk of metastasis and prostate cancer death by 1.0% to 2.4% and 0.6% to 1.6%, respectively. There was little difference between annual and 5-year biopsy schedules in terms of LYs (range of differences, 0.04-0.16 LYs) and quality-adjusted LYs (range of differences, −0.02 to 0.09 quality-adjusted LYs). Conclusions: Among men diagnosed with GS ≤6 prostate cancer, obtaining a biopsy every 3 or 4 years appears to be an acceptable alternative to more frequent biopsies. Reducing surveillance intensity for those who have a low risk of progression reduces the number of biopsies while preserving the benefit of more frequent schedules.

Original languageEnglish (US)
JournalCancer
DOIs
StateAccepted/In press - Jan 1 2019

Fingerprint

Prostatic Neoplasms
Neoplasm Metastasis
Biopsy
Mortality
Quality-Adjusted Life Years
Neoplasm Grading
Appointments and Schedules
Watchful Waiting
Quality of Life
Canaries
San Francisco

Keywords

  • active surveillance
  • biopsy
  • Gleason score
  • microsimulation
  • prostate cancer

ASJC Scopus subject areas

  • Oncology
  • Cancer Research

Cite this

Lange, J. M., Laviana, A. A., Penson, D. F., Lin, D. W., Bill-Axelson, A., Carlsson, S. V., ... Etzioni, R. B. (Accepted/In press). Prostate cancer mortality and metastasis under different biopsy frequencies in North American active surveillance cohorts. Cancer. https://doi.org/10.1002/cncr.32557

Prostate cancer mortality and metastasis under different biopsy frequencies in North American active surveillance cohorts. / Lange, Jane M.; Laviana, Aaron A.; Penson, David F.; Lin, Daniel W.; Bill-Axelson, Anna; Carlsson, Sigrid V.; Newcomb, Lisa F.; Trock, Bruce J.; Carter, H. Ballentine; Carroll, Peter R.; Cooperberg, Mathew R.; Cowan, Janet E.; Klotz, Laurence H.; Etzioni, Ruth B.

In: Cancer, 01.01.2019.

Research output: Contribution to journalArticle

Lange, JM, Laviana, AA, Penson, DF, Lin, DW, Bill-Axelson, A, Carlsson, SV, Newcomb, LF, Trock, BJ, Carter, HB, Carroll, PR, Cooperberg, MR, Cowan, JE, Klotz, LH & Etzioni, RB 2019, 'Prostate cancer mortality and metastasis under different biopsy frequencies in North American active surveillance cohorts', Cancer. https://doi.org/10.1002/cncr.32557
Lange, Jane M. ; Laviana, Aaron A. ; Penson, David F. ; Lin, Daniel W. ; Bill-Axelson, Anna ; Carlsson, Sigrid V. ; Newcomb, Lisa F. ; Trock, Bruce J. ; Carter, H. Ballentine ; Carroll, Peter R. ; Cooperberg, Mathew R. ; Cowan, Janet E. ; Klotz, Laurence H. ; Etzioni, Ruth B. / Prostate cancer mortality and metastasis under different biopsy frequencies in North American active surveillance cohorts. In: Cancer. 2019.
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abstract = "Background: Active surveillance (AS) is an accepted means of managing low-risk prostate cancer. Because of the rarity of downstream events, data from existing AS cohorts cannot yet address how differences in surveillance intensity affect metastasis and mortality. This study projected the comparative benefits of different AS schedules in men diagnosed with prostate cancer who had Gleason score (GS) ≤6 disease and risk profiles similar to those in North American AS cohorts. Methods: Times of GS upgrading were simulated based on AS data from the University of Toronto, Johns Hopkins University, the University of California at San Francisco, and the Canary Pass Active Surveillance Cohort. Times to metastasis and prostate cancer death, informed by models from the Scandinavian Prostate Cancer Group 4 trial, were projected under biopsy surveillance schedules ranging from watchful waiting to annual biopsies. Outcomes included the risk of metastasis, the risk of death, remaining life-years (LYs), and quality-adjusted LYs. Results: Compared with watchful waiting, AS biopsies reduced the risk of prostate cancer metastasis and prostate cancer death at 20 years by 1.4{\%} to 3.3{\%} and 1.0{\%} to 2.4{\%}, respectively; and 5-year biopsies reduced the risk of metastasis and prostate cancer death by 1.0{\%} to 2.4{\%} and 0.6{\%} to 1.6{\%}, respectively. There was little difference between annual and 5-year biopsy schedules in terms of LYs (range of differences, 0.04-0.16 LYs) and quality-adjusted LYs (range of differences, −0.02 to 0.09 quality-adjusted LYs). Conclusions: Among men diagnosed with GS ≤6 prostate cancer, obtaining a biopsy every 3 or 4 years appears to be an acceptable alternative to more frequent biopsies. Reducing surveillance intensity for those who have a low risk of progression reduces the number of biopsies while preserving the benefit of more frequent schedules.",
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author = "Lange, {Jane M.} and Laviana, {Aaron A.} and Penson, {David F.} and Lin, {Daniel W.} and Anna Bill-Axelson and Carlsson, {Sigrid V.} and Newcomb, {Lisa F.} and Trock, {Bruce J.} and Carter, {H. Ballentine} and Carroll, {Peter R.} and Cooperberg, {Mathew R.} and Cowan, {Janet E.} and Klotz, {Laurence H.} and Etzioni, {Ruth B.}",
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T1 - Prostate cancer mortality and metastasis under different biopsy frequencies in North American active surveillance cohorts

AU - Lange, Jane M.

AU - Laviana, Aaron A.

AU - Penson, David F.

AU - Lin, Daniel W.

AU - Bill-Axelson, Anna

AU - Carlsson, Sigrid V.

AU - Newcomb, Lisa F.

AU - Trock, Bruce J.

AU - Carter, H. Ballentine

AU - Carroll, Peter R.

AU - Cooperberg, Mathew R.

AU - Cowan, Janet E.

AU - Klotz, Laurence H.

AU - Etzioni, Ruth B.

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N2 - Background: Active surveillance (AS) is an accepted means of managing low-risk prostate cancer. Because of the rarity of downstream events, data from existing AS cohorts cannot yet address how differences in surveillance intensity affect metastasis and mortality. This study projected the comparative benefits of different AS schedules in men diagnosed with prostate cancer who had Gleason score (GS) ≤6 disease and risk profiles similar to those in North American AS cohorts. Methods: Times of GS upgrading were simulated based on AS data from the University of Toronto, Johns Hopkins University, the University of California at San Francisco, and the Canary Pass Active Surveillance Cohort. Times to metastasis and prostate cancer death, informed by models from the Scandinavian Prostate Cancer Group 4 trial, were projected under biopsy surveillance schedules ranging from watchful waiting to annual biopsies. Outcomes included the risk of metastasis, the risk of death, remaining life-years (LYs), and quality-adjusted LYs. Results: Compared with watchful waiting, AS biopsies reduced the risk of prostate cancer metastasis and prostate cancer death at 20 years by 1.4% to 3.3% and 1.0% to 2.4%, respectively; and 5-year biopsies reduced the risk of metastasis and prostate cancer death by 1.0% to 2.4% and 0.6% to 1.6%, respectively. There was little difference between annual and 5-year biopsy schedules in terms of LYs (range of differences, 0.04-0.16 LYs) and quality-adjusted LYs (range of differences, −0.02 to 0.09 quality-adjusted LYs). Conclusions: Among men diagnosed with GS ≤6 prostate cancer, obtaining a biopsy every 3 or 4 years appears to be an acceptable alternative to more frequent biopsies. Reducing surveillance intensity for those who have a low risk of progression reduces the number of biopsies while preserving the benefit of more frequent schedules.

AB - Background: Active surveillance (AS) is an accepted means of managing low-risk prostate cancer. Because of the rarity of downstream events, data from existing AS cohorts cannot yet address how differences in surveillance intensity affect metastasis and mortality. This study projected the comparative benefits of different AS schedules in men diagnosed with prostate cancer who had Gleason score (GS) ≤6 disease and risk profiles similar to those in North American AS cohorts. Methods: Times of GS upgrading were simulated based on AS data from the University of Toronto, Johns Hopkins University, the University of California at San Francisco, and the Canary Pass Active Surveillance Cohort. Times to metastasis and prostate cancer death, informed by models from the Scandinavian Prostate Cancer Group 4 trial, were projected under biopsy surveillance schedules ranging from watchful waiting to annual biopsies. Outcomes included the risk of metastasis, the risk of death, remaining life-years (LYs), and quality-adjusted LYs. Results: Compared with watchful waiting, AS biopsies reduced the risk of prostate cancer metastasis and prostate cancer death at 20 years by 1.4% to 3.3% and 1.0% to 2.4%, respectively; and 5-year biopsies reduced the risk of metastasis and prostate cancer death by 1.0% to 2.4% and 0.6% to 1.6%, respectively. There was little difference between annual and 5-year biopsy schedules in terms of LYs (range of differences, 0.04-0.16 LYs) and quality-adjusted LYs (range of differences, −0.02 to 0.09 quality-adjusted LYs). Conclusions: Among men diagnosed with GS ≤6 prostate cancer, obtaining a biopsy every 3 or 4 years appears to be an acceptable alternative to more frequent biopsies. Reducing surveillance intensity for those who have a low risk of progression reduces the number of biopsies while preserving the benefit of more frequent schedules.

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