Evaluating long-term active surveillance for early-stage prostate cancer.

This study was carried out to assess the long-term outcomes of men diagnosed with prostate cancer (PC) undergoing active surveillance (AS) and factors that predicted the risk of their cancer spreading (metastasizing). The authors found that AS is a safe and viable option for men with low-risk and carefully-selected intermediate-risk PC. 

PC is one of the most common forms of cancer found in men. AS is the monitoring of a disease using blood tests and imaging techniques such as MRI in order to avoid or delay unnecessary treatment. The long-term risks of PC spreading in men under AS remains under investigation. 

A total of 1450 men were included in this study. All men had early-stage PC and were under AS. The average length of follow-up was 77 months.

The 7-year cancer spread-free survival rate of patients was 99%. Cancer spread occurred in 15 men at an average time-frame of 62 months. 69% of this cancer spread was localized to the lymph nodes surrounding the prostate gland. 

Patients with a lower Gleason grade had a lower cancer spread rate compared to those with a higher grade. The Gleason grade is a tool used to measure the aggressiveness of PC using samples from a prostate biopsy (tissue sampling procedure). PCs with a higher Gleason score are more aggressive and have poorer outcomes. Also, a higher prostate-specific antigen (PSA) level was linked with an increased risk of cancer spread. PSA is a protein made by the prostate that indicated the presence of PC.

The authors found that AS is a safe and viable option for men with low-risk and carefully-selected intermediate-risk PC. Factors such as a high Gleason score, magnetic resonance imaging (MRI) scans, and PSA levels were useful as predictive factors when selecting patients for AS.

This study was based on data from medical records. Not all men underwent the same diagnostic assessment.