Hard pass.

Top Line: Can you individually estimate a man’s risk of progression while on active surveillance (AS)?

The Study: The Canary Prostate Active Surveillance Study (PASS) is an ongoing, prospective AS trial where men get a surveillance PSA every 3 months, a clinic visit every 6 months, and repeat biopsies between 6 to 12 months, at 24 months, and then every 2 years after diagnosis. This study specifically focuses on a sub-group of 850 patients with initial grade group 1 (GG 1) disease who had GG 1 disease again on their first surveillance biopsy at 6-12 months. Clinical data from these men were then used to develop a model to predict disease reclassification, and it was validated on a cohort of men from UCSF. The model includes multiple clinical variables that were independently associated with disease upgrading. There’s a handy web-based calculator you can use to estimate a man’s risk of Gleason upgrading over 4 years. It stratifies men into low, intermediate, and high risk categories. Among men in the lowest 25th and 10th lowest percentiles, the calculator’s negative predictive value for upgrading was 0.88 and 0.95, respectively. Such men could potentially be considered for less-invasive, or at least less frequently invasive AS protocols. 

TBL: The Canary PASS Progression Calculator is a useful tool to assess a man’s risk of pathologic upgrading during active surveillance (but following a confirmatory biopsy at 6-12 months). | Cooperberg, JAMA Oncol 2020

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