De-escalation of Monitoring in Active Surveillance for Prostate Cancer: Results from the GAP3 Consortium

Yoichiro Tohi; John M Sahrmann; Jaron Arbet; Takuma Kato; Lui Shiong Lee; Michael Peacock; Kevin Ginsburg; Christian Pavlovich; Peter Carroll; Chris H Bangma; Global Action Plan Prostate Cancer Active Surveillance (GAP3) Consortium; Mikio Sugimoto; Paul C Boutros

doi:10.1016/j.euo.2024.07.006

De-escalation of Monitoring in Active Surveillance for Prostate Cancer: Results from the GAP3 Consortium

Yoichiro Tohi^*, John M Sahrmann, Jaron Arbet, Takuma Kato, Lui Shiong Lee, Michael Peacock, Kevin Ginsburg, Christian Pavlovich, Peter Carroll, Chris H Bangma, Global Action Plan Prostate Cancer Active Surveillance (GAP3) Consortium, Mikio Sugimoto, Paul C Boutros

^*Corresponding author for this work

Urology

Research output: Contribution to journal › Article › Academic › peer-review

2 Citations (Scopus)

Abstract

BACKGROUND AND OBJECTIVE: There is no consensus on de-escalation of monitoring during active surveillance (AS) for prostate cancer (PCa). Our objective was to determine clinical criteria that can be used in decisions to reduce the intensity of AS monitoring.

METHODS: The global prospective AS cohort from the Global Action Plan prostate cancer AS consortium was retrospectively analyzed. The 24656 patients with complete outcome data were considered. The primary goal was to develop a model identifying a subgroup with a high ratio of other-cause mortality (OCM) to PCa-specific mortality (PCSM). Nonparametric competing-risks models were used to estimate cause-specific mortality. We hypothesized that the subgroup with the highest OCM/PCSM ratio would be good candidates for de-escalation of AS monitoring.

KEY FINDINGS AND LIMITATIONS: Cumulative mortality at 15 yr, accounting for censoring, was 1.3% for PCSM, 11.5% for OCM, and 18.7% for death from unknown causes. We identified body mass index (BMI) >25 kg/m2 and <11% positive cores at initial biopsy as an optimal set of criteria for discriminating OCM from PCSM. The 15-yr OCM/PCSM ratio was 34.2 times higher for patients meeting these criteria than for those not meeting the criteria. According to these criteria, 37% of the cohort would be eligible for de-escalation of monitoring. Limitations include the retrospective nature of the study and the lack of external validation.

CONCLUSIONS: Our study identified BMI >25 kg/m2 and <11% positive cores at initial biopsy as clinical criteria for de-escalation of AS monitoring in PCa.

PATIENT SUMMARY: We investigated factors that could help in deciding on when to reduce the intensity of monitoring for patients on active surveillance for prostate cancer. We found that patients with higher BMI (body mass index) and lower prostate cancer volume may be good candidates for less intensive monitoring. This model could help doctors and patients in making decisions on active surveillance for prostate cancer.

Original language	English
Pages (from-to)	347-354
Number of pages	8
Journal	European urology oncology
Volume	8
Issue number	2
Early online date	31 Jul 2024
DOIs	https://doi.org/10.1016/j.euo.2024.07.006
Publication status	Published - Apr 2025

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10.1016/j.euo.2024.07.006

1-s2.0-S2588931124001792-mainFinal published version, 965 KBLicence: Article 25fa Dutch Copyright Act

Cite this

Tohi, Y., Sahrmann, J. M., Arbet, J., Kato, T., Lee, L. S., Peacock, M., Ginsburg, K., Pavlovich, C., Carroll, P., Bangma, C. H., Global Action Plan Prostate Cancer Active Surveillance (GAP3) Consortium, Sugimoto, M., & Boutros, P. C. (2025). De-escalation of Monitoring in Active Surveillance for Prostate Cancer: Results from the GAP3 Consortium. European urology oncology, 8(2), 347-354. https://doi.org/10.1016/j.euo.2024.07.006

@article{057ea79c126149ea8f5475d3b73ae9e6,

title = "De-escalation of Monitoring in Active Surveillance for Prostate Cancer: Results from the GAP3 Consortium",

abstract = "BACKGROUND AND OBJECTIVE: There is no consensus on de-escalation of monitoring during active surveillance (AS) for prostate cancer (PCa). Our objective was to determine clinical criteria that can be used in decisions to reduce the intensity of AS monitoring.METHODS: The global prospective AS cohort from the Global Action Plan prostate cancer AS consortium was retrospectively analyzed. The 24656 patients with complete outcome data were considered. The primary goal was to develop a model identifying a subgroup with a high ratio of other-cause mortality (OCM) to PCa-specific mortality (PCSM). Nonparametric competing-risks models were used to estimate cause-specific mortality. We hypothesized that the subgroup with the highest OCM/PCSM ratio would be good candidates for de-escalation of AS monitoring.KEY FINDINGS AND LIMITATIONS: Cumulative mortality at 15 yr, accounting for censoring, was 1.3% for PCSM, 11.5% for OCM, and 18.7% for death from unknown causes. We identified body mass index (BMI) >25 kg/m2 and <11% positive cores at initial biopsy as an optimal set of criteria for discriminating OCM from PCSM. The 15-yr OCM/PCSM ratio was 34.2 times higher for patients meeting these criteria than for those not meeting the criteria. According to these criteria, 37% of the cohort would be eligible for de-escalation of monitoring. Limitations include the retrospective nature of the study and the lack of external validation.CONCLUSIONS: Our study identified BMI >25 kg/m2 and <11% positive cores at initial biopsy as clinical criteria for de-escalation of AS monitoring in PCa.PATIENT SUMMARY: We investigated factors that could help in deciding on when to reduce the intensity of monitoring for patients on active surveillance for prostate cancer. We found that patients with higher BMI (body mass index) and lower prostate cancer volume may be good candidates for less intensive monitoring. This model could help doctors and patients in making decisions on active surveillance for prostate cancer.",

author = "Yoichiro Tohi and Sahrmann, {John M} and Jaron Arbet and Takuma Kato and Lee, {Lui Shiong} and Michael Peacock and Kevin Ginsburg and Christian Pavlovich and Peter Carroll and Bangma, {Chris H} and {Global Action Plan Prostate Cancer Active Surveillance (GAP3) Consortium} and Mikio Sugimoto and Boutros, {Paul C}",

year = "2025",

month = apr,

doi = "10.1016/j.euo.2024.07.006",

language = "English",

volume = "8",

pages = "347--354",

journal = "European urology oncology",

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Tohi, Y, Sahrmann, JM, Arbet, J, Kato, T, Lee, LS, Peacock, M, Ginsburg, K, Pavlovich, C, Carroll, P, Bangma, CH, Global Action Plan Prostate Cancer Active Surveillance (GAP3) Consortium, Sugimoto, M & Boutros, PC 2025, 'De-escalation of Monitoring in Active Surveillance for Prostate Cancer: Results from the GAP3 Consortium', European urology oncology, vol. 8, no. 2, pp. 347-354. https://doi.org/10.1016/j.euo.2024.07.006

TY - JOUR

T1 - De-escalation of Monitoring in Active Surveillance for Prostate Cancer

T2 - Results from the GAP3 Consortium

AU - Tohi, Yoichiro

AU - Sahrmann, John M

AU - Arbet, Jaron

AU - Kato, Takuma

AU - Lee, Lui Shiong

AU - Peacock, Michael

AU - Ginsburg, Kevin

AU - Pavlovich, Christian

AU - Carroll, Peter

AU - Bangma, Chris H

AU - Global Action Plan Prostate Cancer Active Surveillance (GAP3) Consortium

AU - Sugimoto, Mikio

AU - Boutros, Paul C

PY - 2025/4

Y1 - 2025/4

N2 - BACKGROUND AND OBJECTIVE: There is no consensus on de-escalation of monitoring during active surveillance (AS) for prostate cancer (PCa). Our objective was to determine clinical criteria that can be used in decisions to reduce the intensity of AS monitoring.METHODS: The global prospective AS cohort from the Global Action Plan prostate cancer AS consortium was retrospectively analyzed. The 24656 patients with complete outcome data were considered. The primary goal was to develop a model identifying a subgroup with a high ratio of other-cause mortality (OCM) to PCa-specific mortality (PCSM). Nonparametric competing-risks models were used to estimate cause-specific mortality. We hypothesized that the subgroup with the highest OCM/PCSM ratio would be good candidates for de-escalation of AS monitoring.KEY FINDINGS AND LIMITATIONS: Cumulative mortality at 15 yr, accounting for censoring, was 1.3% for PCSM, 11.5% for OCM, and 18.7% for death from unknown causes. We identified body mass index (BMI) >25 kg/m2 and <11% positive cores at initial biopsy as an optimal set of criteria for discriminating OCM from PCSM. The 15-yr OCM/PCSM ratio was 34.2 times higher for patients meeting these criteria than for those not meeting the criteria. According to these criteria, 37% of the cohort would be eligible for de-escalation of monitoring. Limitations include the retrospective nature of the study and the lack of external validation.CONCLUSIONS: Our study identified BMI >25 kg/m2 and <11% positive cores at initial biopsy as clinical criteria for de-escalation of AS monitoring in PCa.PATIENT SUMMARY: We investigated factors that could help in deciding on when to reduce the intensity of monitoring for patients on active surveillance for prostate cancer. We found that patients with higher BMI (body mass index) and lower prostate cancer volume may be good candidates for less intensive monitoring. This model could help doctors and patients in making decisions on active surveillance for prostate cancer.

AB - BACKGROUND AND OBJECTIVE: There is no consensus on de-escalation of monitoring during active surveillance (AS) for prostate cancer (PCa). Our objective was to determine clinical criteria that can be used in decisions to reduce the intensity of AS monitoring.METHODS: The global prospective AS cohort from the Global Action Plan prostate cancer AS consortium was retrospectively analyzed. The 24656 patients with complete outcome data were considered. The primary goal was to develop a model identifying a subgroup with a high ratio of other-cause mortality (OCM) to PCa-specific mortality (PCSM). Nonparametric competing-risks models were used to estimate cause-specific mortality. We hypothesized that the subgroup with the highest OCM/PCSM ratio would be good candidates for de-escalation of AS monitoring.KEY FINDINGS AND LIMITATIONS: Cumulative mortality at 15 yr, accounting for censoring, was 1.3% for PCSM, 11.5% for OCM, and 18.7% for death from unknown causes. We identified body mass index (BMI) >25 kg/m2 and <11% positive cores at initial biopsy as an optimal set of criteria for discriminating OCM from PCSM. The 15-yr OCM/PCSM ratio was 34.2 times higher for patients meeting these criteria than for those not meeting the criteria. According to these criteria, 37% of the cohort would be eligible for de-escalation of monitoring. Limitations include the retrospective nature of the study and the lack of external validation.CONCLUSIONS: Our study identified BMI >25 kg/m2 and <11% positive cores at initial biopsy as clinical criteria for de-escalation of AS monitoring in PCa.PATIENT SUMMARY: We investigated factors that could help in deciding on when to reduce the intensity of monitoring for patients on active surveillance for prostate cancer. We found that patients with higher BMI (body mass index) and lower prostate cancer volume may be good candidates for less intensive monitoring. This model could help doctors and patients in making decisions on active surveillance for prostate cancer.

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U2 - 10.1016/j.euo.2024.07.006

DO - 10.1016/j.euo.2024.07.006

M3 - Article

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SN - 2588-9311

VL - 8

SP - 347

EP - 354

JO - European urology oncology

JF - European urology oncology

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ER -

De-escalation of Monitoring in Active Surveillance for Prostate Cancer: Results from the GAP3 Consortium

Abstract

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