No significant difference in intermediate key outcomes in men with low- and intermediate-risk prostate cancer managed by active surveillance

Sci Rep. 2022 Apr 25;12(1):6743. doi: 10.1038/s41598-022-10741-8.


Active surveillance (AS) is standard of care for patients with low-risk prostate cancer (PCa), but its feasibility in intermediate-risk patients is controversial. We compared outcomes of low- and intermediate-risk patients managed with multiparametric magnetic resonance imaging (mpMRI)-supported AS in a community hospital. Of the 433 patients enrolled in AS between 2009 and 2016, 358 complied with AS inclusion criteria (Cancer of the Prostate Risk Assessment (CAPRA) score ≤ 5, Gleason grade group (GGG) ≤ 2, clinical stage ≤ cT2 and prostate-specific antigen (PSA) ≤ 20 ng/ml) and discontinuation criteria (histological-, PSA-, clinical- or radiological disease reclassification). Of the 358 patients, 177 (49%) were low-risk and 181 (51%) were intermediate-risk. Median follow-up was 4.2 years. The estimated 5-year treatment-free survival (TFS) was 56% (95% confidence interval [CI] 51-62%). Intermediate-risk patients had significantly shorter TFS compared with low-risk patients (hazard ratio 2.01, 95% CI 1.47-2.76, p < 0.001). There were no statistically significant differences in the rate of adverse pathology, biochemical recurrence-free survival and overall survival between low- and intermediate-risk patients. Two patients developed metastatic disease and three died of PCa. These results suggest that selected patients with intermediate-risk PCa may be safely managed by mpMRI-supported AS, but longer follow-up is necessary.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Humans
  • Male
  • Multiparametric Magnetic Resonance Imaging*
  • Prostate-Specific Antigen
  • Prostatic Neoplasms* / diagnostic imaging
  • Prostatic Neoplasms* / therapy
  • Risk Assessment / methods
  • Watchful Waiting


  • Prostate-Specific Antigen