Long-term outcomes of active surveillance for localized prostate cancer.

This study aimed to investigate the outcomes of active surveillance (AS) in the treatment of localized prostate cancer. This study recommends the use of AS for men with localized prostate cancer.

Treatments for prostate cancer often result in serious side effects such as impaired bowel, bladder or sexual functions. To avoid these, in patients with early-stage prostate cancer,  active surveillance (AS) is often recommended instead of active treatment. This involves monitoring the prostate for any changes by regular testing. This monitoring can be done using magnetic resonance imaging (MRI), the prostate-specific antigen (PSA; a substance produced by the prostate) as a marker and doing regular biopsies of the prostate. 

The long-term outcomes of men on AS are still under investigation.

This study included 936 men with localized prostate cancer. All patients were recommended AS. 223 men were classified with very low-risk prostate cancer and 436 men with low-risk prostate cancer. 259 men were classified with medium-risk prostate cancer and 18 men with high-risk prostate cancer. They were followed up for an average of 7.5 years. During follow-up, 320 men underwent active treatment. 250 men underwent prostate surgery, 53 men underwent external radiotherapy and 15 men underwent brachytherapy (internal radiotherapy). 

At 10 years, patients who had no treatment had an estimated survival of 62.8%. This was 92.2% for men who had hormonal therapy. The 10-year survival with hormone therapy-sensitive cancer was 97.2%. Compared to men with low-risk prostate cancer, men with medium-risk prostate cancer had a higher survival without active treatment (69% vs. 56%). 

This study recommends the use of AS as a treatment option for men with localized prostate cancer.

This study was based in Denmark. These results may not apply to all populations.