Is active surveillance suitable for prostate cancer patients regardless of age?

This study aimed to investigate the relationship between patient age and active surveillance outcomes in prostate cancer (PC).

This study concluded that younger patients undergoing AS were less likely to see an increased Gleason score and progression. 

Early stage PC that has not yet spread is often not treated initially. Active surveillance (AS) is a method that can be used to monitor PC. AS involves prostate specific antigen (PSA) blood tests, biopsies and digital rectal examinations.  PSA is a protein found elevated in PC patients. Biopsies involve removing a prostate tissue sample and digital rectal examinations involve monitoring the size of the prostate gland.

By using AS, the onset of treatment can be delayed and unnecessary treatment avoided. The use of AS in PC patients is increasing. Whether or not AS is effective in early stage PC in younger men, and if age is linked to outcome, is unknown.

This study involved 1433 men with PC undergoing AS. Patients were monitored for an average of 49 months. 42% of these men were aged 60 or under (younger group) and the remaining 58% were aged over 60 (older group).

The Gleason score is a measure of the aggressiveness of the cancer cells removed during a biopsy. The 3-year Gleason score upgrade-free rate (no increase in Gleason score) was 73% for men in the younger group and 64% for men in the older group. The 5-year Gleason score upgrade-free rate was 55% for men in the younger group and 48% for men in the older group.

The risk of Gleason score upgrade decreased by 3% for every year younger than 60 at diagnosis. The risk of disease progression also decreased by 3% per year age at diagnosis.

The rates of definitive (first) treatment were similar in both age groups. However, there was an age-related difference in the type of definitive treatment. The younger age group received more radial prostatectomies (removal of prostate) than radiation therapy while the opposite was true for the older age group.

This study concluded that younger patients undergoing AS were less likely to see an increased Gleason score and progression. It was also found that younger and older patients had the same risk of definitive treatment but the types of treatment differed. 

There were several limitations to this study. More studies are needed to further support the findings. 

Consult your physician about the option of active surveillance.