Identification Of Optimal Candidates For Active Surveillance For Intermediate-risk Prostate Cancer

Background Prostate cancer is the most common malignancy in men at present,and the commonly used treatment methods include radical prostate cancer,local radiotherapy and endocrine therapy.For low-risk prostate cancer patients,active surveillance has gradually become the clinician’s alternative to active treatment.However,there are limited clinical studies and data on active surveillance for patients with moderate risk prostate cancer,and the criteria for inclusion in these clinical studies are not uniform.Therefore,whether patients with intermediate-risk prostate cancer are suitable for active monitoring treatment is worthy of further discussion and research.Methods Surveillance,Epidemiology,and End Results were obtained from the National Cancer Research Center Surveillance administration(Surveillance,Epidemiology,and End Results;Seer)database,and Cox proportional risk regression model was used to analyze the influence of clinicopathological characteristics on prognosis of patients pathologically diagnosed as intermediate-risk prostate cancer during 2010-2015.KM survival curve analysis and log-rank test were used to evaluate the prognostic differences between groups and to plot the survival curve.The Cox proportional risk regression model was used to predict the mortality rate of patients undergoing radical prostate cancer treatment.To assess whether the benefits of radical prostate cancer surgery differ depending on the predicted risk,we analyzed whether there is an interaction between radical prostate cancer surgery and treatment modality.Results A total of 30,787 intermediate-risk prostate cancer patients with complete clinical and follow-up information who underwent radical prostatectomy and active monitoring were included in this study.The overall median follow-up time was 48 months,and the overall 6-year mortality rate was 4.5%.The median follow-up time was 44 months,with an overall 6-year mortality rate of 3.6%.The median follow-up time was 38 months,and the overall 6-year mortality rate was 14.8%.KM survival curve analysis showed that patients with moderate risk prostate cancer who were actively monitored had a worse prognosis than those who underwent radical prostate cancer(HR=4.1;95%CI: 3.2-5.3).Multivariate Cox analysis showed that PSA,age,treatment,ISUP level,marital status and race were the prognostic factors of moderate risk prostate cancer patients.We successfully constructed a model to predict the prognosis of patients treated with active monitoring.The consistency index and correction curve indicate that the model has good predictive power.The interaction between treatment modalities and predicted mortality was statistically significant(P<0.001),suggesting that when the model predicted a 6-year mortality of 6.4% or less,the actual 6-year overall mortality rate for patients who were actively monitored was lower than that for patients undergoing radical prostatectomy.At the same time,the KM survival curve analysis indicated that there was no statistically significant difference in the prognosis of patients with 6-year mortality less than or equal to 6.4% after active monitoring compared with radical prostatectomy(P=0.57).Conclusion This study analyzed the prognostic factors of patients with intermediate-risk prostate cancer,and successfully established a prognostic model to identify the best candidates for active surveillance and treatment of moderate risk prostate cancer.Personalized treatment for clinically intermediate-risk prostate patients has practical clinical significance,but at the same time,more clinical coalitions are needed to verify and improve the prognostic model and cutoff value.