Key clinical point: In the long term, active surveillance (AS) is a safe and viable option for men with low-risk and carefully selected intermediate-risk prostate cancer. Gleason grade (GG) 2, prostate-specific antigen (PSA) velocity, and Prostate Imaging Reporting and Data System (PI-RADS) 4-5 lesions were associated with significant risk for metastasis.

Major finding: The 7-year metastasis-free survival rate was 99% and median time to metastases was 62 months. 69% of metastases developed in lymph nodes. Patients with GG2 had a lower metastasis-free survival rate vs. those with GG1 disease (P less than .01). Independent predictors (hazard ratios; 95% confidence intervals) of metastases included GG2 (19.8; 4.9-79.3), PSA velocity (1.4; 1.1-1.7), and PI-RADS 4-5 lesions (8.5; 2.2-33.1). The 7-year prostate cancer-specific survival was greater than 99%.

Study details: A retrospective study of 1,450 patients (median age, 62 years) with low- or intermediate-risk prostate cancer managed with active surveillance; median follow-up was 77 months.

Disclosures: The study was supported by the University of California San Francisco Goldberg-Benioff Program in Cancer Translational Biology. The authors declared no conflicts of interest.