ArticleBJU international2026
Active surveillance for intermediate risk prostate cancer: the Manitoba Prostate Center experience.
Article in BJU international, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
objectivesTo report long-term oncological outcomes of men with intermediate-risk prostate cancer managed with active surveillance at a single centre. SUBJECTS/PATIENTS AND
methodsWe retrospectively analysed a prospectively maintained Manitoba Prostate Centre active surveillance database. Included were men with disease classed per National Comprehensive Cancer Network risk categories: very low-, low-, favourable intermediate-, and unfavourable intermediate-risk prostate cancer managed with surveillance (2004-2023). Active surveillance involved serial prostate-specific antigen testing, digital rectal exam, and confirmatory/surveillance biopsies. Outcomes were treatment-free survival, metastasis-free survival, prostate cancer-specific survival, overall survival, and biopsy grade progression. Kaplan-Meier estimated survival; Cox regression evaluated variables associated with outcomes.
resultsAmong 561 men, the median age was 65 years (interquartile range 59-69) and the median follow-up was 4.4 years. Overall, 256 men (45.6%) transitioned to definitive treatment. Five-year treatment-free survival declined stepwise by risk group: 84.8% in very low-risk, 61.4% in low-risk, 50.0% in favourable intermediate-risk, and 21.4% in unfavourable intermediate-risk disease (P < 0.001). On multivariable analysis, older age, higher prostate-specific antigen density, and grade group ≥2 were independently associated with earlier treatment. Metastatic progression and prostate cancer-specific mortality were rare across the cohort, with higher event rates observed among patients with unfavourable intermediate-risk disease.
conclusionsIn this real-world active surveillance cohort, the likelihood of remaining on surveillance differed substantially by baseline risk, with unfavourable intermediate-risk disease associated with earlier transition to treatment and higher risks of disease progression. Older age, higher prostate-specific antigen density, and grade group ≥2 were independently associated with discontinuation of active surveillance. Despite less intensive surveillance protocols, rates of metastatic progression and prostate cancer-specific mortality remained low, particularly among patients with low-risk and favourable intermediate-risk disease, supporting active surveillance as a viable management strategy in carefully selected men beyond low-risk disease.
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