Exploring the relation of active surveillance schedules and prostate cancer mortality

• Published in: Cancer medicine (Malden, MA) Vol. 13; no. 5; pp. e6977 - n/a
• Main Authors: Yang, Zhenwei, Heijnsdijk, Eveline A. M., Newcomb, Lisa F., Rizopoulos, Dimitris, Erler, Nicole S.
• Format: Journal Article
• Language: English
• Published: United States John Wiley & Sons, Inc 01.03.2024; Wiley
• Subjects: active surveillance; Antigens; Biopsy; Biopsy - methods; biopsy schedules; Calibration; cancer mortality; Compliance; detection delay; Disease Progression; Humans; Male; Metastasis; microsimulation model; Mortality; Patients; Probability; Prostate - pathology; Prostate cancer; Prostate-Specific Antigen; Prostatic Neoplasms - pathology; Schedules; Surveillance; Watchful Waiting - methods; biopsy schedules; detection delay; prostate cancer; active surveillance; microsimulation model; cancer mortality
• ISSN: 2045-7634; 2045-7634
• DOI: 10.1002/cam4.6977

Background Active surveillance (AS), where treatment is deferred until cancer progression is detected by a biopsy, is acknowledged as a way to reduce overtreatment in prostate cancer. However, a consensus on the frequency of taking biopsies while in AS is lacking. In former studies to optimize biopsy schedules, the delay in progression detection was taken as an evaluation indicator and believed to be associated with the long‐term outcome, prostate cancer mortality. Nevertheless, this relation was never investigated in empirical data. Here, we use simulated data from a microsimulation model to fill this knowledge gap. Methods In this study, the established MIcrosimulation SCreening Analysis model was extended with functionality to simulate the AS procedures. The biopsy sensitivity in the model was calibrated on the Canary Prostate Cancer Active Surveillance Study (PASS) data, and four (tri‐yearly, bi‐yearly, PASS, and yearly) AS programs were simulated. The relation between detection delay and prostate cancer mortality was investigated by Cox models. Results The biopsy sensitivity of progression detection was found to be 50%. The Cox models show a positive relation between a longer detection delay and a higher risk of prostate cancer death. A 2‐year delay resulted in a prostate cancer death risk of 2.46%–2.69% 5 years after progression detection and a 10‐year risk of 5.75%–5.91%. A 4‐year delay led to an approximately 8% greater 5‐year risk and an approximately 25% greater 10‐year risk. Conclusion The detection delay is confirmed as a surrogate for prostate cancer mortality. A cut‐off for a “safe” detection delay could not be identified.