Active surveillance for prostate cancer

This review provided an overview of active surveillance, including suitable patients, discontinuation rates and survival rates.

Radical prostatectomy (surgical removal of the prostate gland) in patients with low-risk prostate cancer has, in clinical trials, failed to improve overall and cancer-specific survival compared to active surveillance (close observation of cancer rather than immediate treatment). Although a general agreement on which patients should receive active surveillance exists, there are some variations in practice.

This review aimed to provide an overview of active surveillance.

In total, 10 publications on active surveillance were included in this analysis, involving 3,550 patients with an average follow-up of 4.5 years. Low-risk prostate cancer was typically defined based on the D’Amico risk classification as cT ≤ 2a (a measure of tumor size), prostate specific antigen (PSA) < 10 ng/ml and Gleason score (microscopic appearance of the cancer cells) ≤ 6.

Patients managed on active surveillance were followed with a combination of repeated biopsies, serial PSA measurements and clinical examinations.

The estimated average 5-year probability of discontinuing active surveillance was 33%. The average 10-year probability of discontinuing was 55%. After discontinuation of active surveillance the majority (80-100%) of patients underwent delayed curative intended treatment (therapy intended to cure) with an even distribution between surgery – radical prostatectomy (26-65%) and external beam radiation therapy (20-67%).

For patients initially managed on active surveillance the 10-year prostate cancer-specific survival was reported between 96% and 100% for both low- and intermediate-risk patients.

The authors concluded that active surveillance seems to be able to reduce over-treatment of low-risk prostate cancer patients without compromising 10-year cancer-specific survival.

Discuss the benefits and limitations of active surveillance with your doctor.