Older men on active surveillance for prostate cancer require additional testing

Older men with Gleason grade group (GG) 1 prostate cancer are more likely to have adverse pathology at radical prostatectomy after initially being managed with active surveillance (AS), a study reports. As such, closer monitoring and additional testing are required to improve their risk stratification.

A total of 365 patients with GG1 prostate cancer initially managed with AS followed by delayed radical prostatectomy participated in the study. Adverse pathology (defined as GG ≥3 or pT3 or pN1) after the procedure, the primary study outcome, was compared among men aged <65 vs ≥65 years at the initiation of AS.

Median prostate specific antigen density, percent positive biopsy cores, multiparametric magnetic resonance imaging (mpMRI) results, or composite genomic classifier scores (derived from three commercially available genomic tests) at diagnosis were similar among patients in the two age groups.

Men ≥65 years had more adverse pathology at radical prostatectomy (59.2 percent vs 44.1 percent; p<0.01) and lower rates of biopsy upgrade-free survival and adverse pathology-free survival (p<0.01).

In multivariable Cox proportional hazards regression models, adverse pathology at radical prostatectomy was associated with age ≥65 years (hazard ratio [HR], 2.21, 95 percent confidence interval [CI], 1.57–3.12).

Further analysis revealed that mpMRI predicted adverse pathology in the older patient group (HR, 3.33, 95 percent CI, 1.01–10.95).