Active Surveillance for Prostate Cancer

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Study findings offer a measure of reassurance about delaying treatment

Active surveillance offers men who have a prostate cancer that is unlikely to cause harm without treatment the option of careful monitoring with the intention to treat for cure should the disease change over time. This management approach is most often recommended for men who have very-low- to low-risk prostate cancers (favorable risk) that are believed to be small volume, especially older men whose cancers are unlikely to become life-threatening during the remaining years of their life.

Some men worry that if they choose, or continue, active surveillance, they will miss an opportunity for a cure because treatment was delayed. Results from a study reported in September 2017 in The Journal of Urology provide a bit of reassurance that they are not disadvantaged by choosing to forgo immediate treatment.

Researchers reviewed data from 94 men diagnosed with very-low- or low-risk prostate cancer and initially chose active surveillance. The men opted to have a radical prostatectomy when PSA testing indicated their cancer had progressed and was reclassified to a higher grade. The researchers compared the medical records of these men with those from patients who had similar tumor grades, but who chose to have a radical prostatectomy right away. Men who initially chose active surveillance but later underwent radical prostatectomy were less likely than men who had immediate surgery to experience a biochemical prostate cancer recurrence. Lab tests indicated that their cancers were less aggressive, too.

The authors caution that the results from this study don’t prove that delaying treatment is risk-free. They note that the favorable results could be because men who were selected for active surveillance had lower-volume disease than those with similar cancer grades at the initial diagnosis. Also, the men in the study were compliant with stringent follow-up biopsy recommendations, and thus the findings may not apply to patients whose follow-up is less rigorous.