Is active surveillance safe?

The study evaluated whether active surveillance (AS) is a safe approach and can prevent over-treatment in patients with prostate cancer. 

In the recent years, survival rates for prostate cancer patients have increased due to more advanced screening methods, which allow for early detection and prevention of disease progression. However, it has been suggested that sometimes patients are being over-treated in the efforts of saving their lives. AS is an alternative treatment option for patients with early stage (localized, not spreading) prostate cancer. AS includes regular digital rectal examinations, prostate-specific antigen or PSA (a protein produced by the prostate gland whose levels increase in prostate cancer) measurements, periodic biopsies (tissue sampling of the cancer) and imaging of the prostate. The main goal of AS is to prevent over-treatment of prostate cancer patients by strictly monitoring them and avoid immediate radical treatments, such as radical prostatectomy or RP (surgical removal of the whole prostate gland and some surrounding tissue). 

67 men participated in this trial. All patients underwent a RP after initial AS. The reasons for RP were evidence of increased tumor or grade on biopsy (46 patients), on MRI or Magnetic Resonance Imaging (an imaging technique that uses magnetic and radio waves to make pictures of tissues – 4 patients) or due to patient preference or anxiety (17 patients). The main parameter evaluated was the rate of developing an unfavorable disease which includes a Gleason score (grading of cancer aggressiveness based on how prostate cancer cells look under a microscope) of 7 or higher, extension of the tumor outside the prostate gland, and spreading of the cancer to the nearby lymph nodes. 

Results showed that 82.1% of the participants had cancer limited to the prostate gland, while only 13.4% had a Gleason score of 7 or higher and 4.4% had positive lymph nodes. Out of the patients who underwent RP due to evidence of cancer progression on biopsy, 34.8% had unfavorable disease and out of the patients who underwent RP due to their preference or anxiety, only 17.6% had an unfavorable disease.

In summary, most of the men undergoing RP after initial AS had confined disease and patients who discontinued AS due to their preference or anxiety tended to undergo RP earlier. These findings may indicate that AS can be a safe approach for early stage prostate cancer patients. 

This study included a very small number of participants. Larger studies are further needed in order to confirm these results.

Consult with your doctor about the most appropriate treatment option for your situation.