Termination rates and histological reclassification of active surveillance patients with low- and early intermediate-risk prostate cancer: results of the PREFERE trial

Peter Albers, Thomas Wiegel, Heinz Schmidberger, Roswitha Bussar-Maatz, Martin Härter, Glen Kristiansen, Peter Martus, Christoph Meisner, Stefan Wellek, Klaus Grozinger, Peter Renner, Martin Burmester, Fried Schneider, Michael Stöckle, Peter Albers, Thomas Wiegel, Heinz Schmidberger, Roswitha Bussar-Maatz, Martin Härter, Glen Kristiansen, Peter Martus, Christoph Meisner, Stefan Wellek, Klaus Grozinger, Peter Renner, Martin Burmester, Fried Schneider, Michael Stöckle

Abstract

Purpose: Active surveillance (AS) strategies for patients with low- and early intermediate-risk prostate cancer are still not consistently defined. Within a controlled randomized trial, active surveillance was compared to other treatment options for patients with prostate cancer. Aim of this analysis was to report on termination rates of patients treated with AS including different grade groups.

Methods: A randomized trial comparing radical prostatectomy, active surveillance, external beam radiotherapy and brachytherapy was performed from 2013 to 2016 and included 345 patients with low- and early intermediate-risk prostate cancer (ISUP grade groups 1 and 2). The trial was prematurely stopped due to slow accrual. A total of 130 patients were treated with active surveillance. Among them, 42 patients were diagnosed with intermediate-risk PCA. Reference pathology and AS quality control were performed throughout.

Results: After a median follow-up time of 18.8 months, 73 out of the 130 patients (56%) terminated active surveillance. Of these, 56 (77%) patients were histologically reclassified at the time of rebiopsy, including 35% and 60% of the grade group 1 and 2 patients, respectively. No patients who underwent radical prostatectomy at the time of reclassification had radical prostatectomy specimens ≥ grade group 3.

Conclusion: In this prospectively analyzed subcohort of patients with AS and conventional staging within a randomized trial, the 2-year histological reclassification rates were higher than those previously reported. Active surveillance may not be based on conventional staging alone, and patients with grade group 2 cancers may be recommended for active surveillance in carefully controlled trials only.

Keywords: Active surveillance; Clinical trial; Prostate cancer; Reclassification.

Conflict of interest statement

Regarding the content of this paper, the authors declare that they have no conflict of interest.

Figures

Fig. 1
Fig. 1
CONSORT table
Fig. 2
Fig. 2
Progression-free survival of patients with active surveillance (AS) in the PREFERE trial (as-treated population) (patients with GS 6 (red) versus GS 7a (blue) tumors). Gleason 6: 31 events; Gleason 7a: 25 events

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Source: PubMed

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