Presentation Authors: Sebastiaan Remmers*, Jozien Helleman, Daan Nieboer, Chris. H. Bangma, Monique J. Roobol, Rotterdam, Netherlands, Movember Foundation’s Global Action Plan Prostate Cancer Active Surveillance (GAP3) consortium, Melbourne, Australia
Introduction: The inclusion of younger men in active surveillance (AS) is still under debate. Our aim was to assess potential differences in incidence, the reason for discontinuation and treatment choice between men under 60 years ( < 60) and men between 60 and 70 years (â‰¥ 60-70) within the Movember Foundation&[prime]s Global Action Plan Prostate Cancer Active Surveillance initiative (GAP3) database.
Methods: The GAP3 initiative has the largest centralized PCa AS database to date including data of over 15,000 men. We compared data from 3353 (29%) men < 60 and 8177 (71%) men â‰¥ 60-70 at time of starting AS, excluding unknowns and men over 70 yrs (N = 3571 men). Characteristics at time at inclusion were compared and cumulative incidence curves were used to estimate rates of AS discontinuation and treatment choice.
Results: Younger men opting for AS have lower PSA at diagnosis (median 4.8, IQR 3.5 - 6.4 ng/ml) than older men (median 5.4, IQR 4.1 - 7.2 ng/ml), and 75% of men < 60 have cT1 PCa compared to 72% in men â‰¥ 60-70. At 1 at 5 years respectively, 6% and 38% of men < 60 have stopped AS compared to 8% and 43% of men â‰¥ 60-70 (Figure 1A-B). After 1 year on AS, 5% of men in both age groups opted for a switch to curative treatment (Figure 1C-D), with equal proportion of men in both age groups opting radical prostatectomy (RP) and radiotherapy (RT). Within both age groups, most men opted for RP. Of the men who underwent RP in the available follow-up, 186 (30%) of men < 60 year and 437 (33%) men â‰¥ 60 and 70 experienced adverse pathology on RP (i.e., â‰¥ pT3, or pT2 with positive surgical margins, or N+, or pathological Gleason â‰¥ 4+3).
Conclusions: Our descriptive analysis of current AS practices worldwide show that taking into account a peak incidence at â‰¥ 60-70 still younger men opting for AS are in minority. This likely reflects the fear of missing progression to clinically significant PCa. The outcomes with respect to discontinuation, reclassification, and adverse pathology on RP are however comparable confirming that AS seems to be a safe treatment option for younger men (Mahran et al., Urology 2018).
Source of Funding: This work was supported by the Movember Foundation. The funder did not play any role in the study design, collection, analysis or interpretation of data, or in the drafting of this paper.