Tumori · 2026
Reducing the burden of active surveillance monitoring examinations in prostate cancer: Insights from real-world data to inform clinical practice.
СтатьяНазвание и аннотация: Перевод в очереди
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Marenghi Cristina, Badenchini Fabio, Avuzzi Barbara, Catanzaro Mario Achille, Casale Alessandra, Casbarra Alessia, Cattaneo Laura, Claps Melanie, Guadalupi Valentina, Macchi Alberto, Messina Antonella, Nazzani Sebastiano, Noris Chiorda Barbara, Procopio Giuseppe, Stagni Silvia, Tesone Antonio, Torelli Tullio, Verzoni Elena, Villa Sergio, Valdagni Riccardo, Rancati Tiziana, Nicolai Nicola
Аннотация
BACKGROUND: Active surveillance (AS) is standard for early-stage prostate cancer, though intensive monitoring continues due to concerns about reclassification to Grade Group (GG) ⩾ 2. We hypothesized that simple and inexpensive clinical parameters could identify patients with indolent disease for whom less intensive monitoring is safe.
METHODS: We analyzed upgrading to ISUP Grade Group (GG) ⩾ 2 in a large cohort of low-risk prostate cancer (PCa) patients on AS. We used mixed-effects logistic regression to develop a model predicting non-upgrading at the next follow-up biopsy, based on routine time-updated clinical-pathological variables.
RESULTS: While annual reclassification persisted at a rate between 10.4% and 17.5% up to the 7th year, upgrades were predominantly GG2. Routine parameters powerfully stratified risk. Patients with a very unfavorable Prostate Specific Antigen (PSA) doubling time had a 40.5% upgrading rate versus 9.5% for those with a favorable value. The final model is based on baseline PSA density and number of positive cores, time-updated age and PSA doubling time category, detection of cancer in the last surveillance biopsy. The model showed moderate discrimination (0.73) in predicting non-upgrading.
CONCLUSIONS: Many patients on AS have indolent disease but steady upgrading justifies monitoring. A model using simple, routine parameters and PSA doubling time can identify those at minimal risk of reclassification, enabling a safe reduction in biopsy intensity. This advocates for a risk-adaptive AS protocol, reserving advanced tools like MRI or biomarkers for the few higher-risk cases.
METHODS: We analyzed upgrading to ISUP Grade Group (GG) ⩾ 2 in a large cohort of low-risk prostate cancer (PCa) patients on AS. We used mixed-effects logistic regression to develop a model predicting non-upgrading at the next follow-up biopsy, based on routine time-updated clinical-pathological variables.
RESULTS: While annual reclassification persisted at a rate between 10.4% and 17.5% up to the 7th year, upgrades were predominantly GG2. Routine parameters powerfully stratified risk. Patients with a very unfavorable Prostate Specific Antigen (PSA) doubling time had a 40.5% upgrading rate versus 9.5% for those with a favorable value. The final model is based on baseline PSA density and number of positive cores, time-updated age and PSA doubling time category, detection of cancer in the last surveillance biopsy. The model showed moderate discrimination (0.73) in predicting non-upgrading.
CONCLUSIONS: Many patients on AS have indolent disease but steady upgrading justifies monitoring. A model using simple, routine parameters and PSA doubling time can identify those at minimal risk of reclassification, enabling a safe reduction in biopsy intensity. This advocates for a risk-adaptive AS protocol, reserving advanced tools like MRI or biomarkers for the few higher-risk cases.