Active surveillance for prostate cancer: current evidence and contemporary state of practice

Abstract

Prostate cancer remains among the most commonly diagnosed malignancies worldwide. Early diagnosis and curative treatment appear to improve survival in men with unfavorable-risk cancers, but significant concerns exist regarding the overdiagnosis and overtreatment of men with lower-risk cancers. To this end, active surveillance (AS) has emerged as a primary management strategy in men with favorable-risk disease, and contemporary data suggest that use of AS has increased worldwide. Although published surveillance cohorts differ by protocol, reported rates of metastatic disease and prostate cancer-specific mortality are exceedingly low in the intermediate term (5–10 years). Such outcomes appear to be closely associated with program-specific criteria for selection, monitoring, and intervention, suggesting that AS – like other management strategies – could be individualized based on the level of risk acceptable to patients in light of personal preferences. Additional data are needed to better establish the risks associated with AS and to identify patient-specific characteristics that could modify prognosis.

Active Surveillance of Prostate Cancer: Use, Outcomes, Imaging, and Diagnostic Tools

“…8 In Toronto, Klotz et al 5 initiated a program of AS aimed at low-risk and select intermediate-risk patients. Their monitoring protocol includes PSA measurements every 3 months for 2 years then every 6 months, with a confirmatory biopsy during the first year and then every 3 to 4 years until age 80.…”

“…8 Nonetheless, based on current methods of patient selection and monitoring, more than one in five men eligible for AS will have evidence of more aggressive disease on prostatectomy. 96 Conversely, some men who fail to meet conventional AS criteria may in fact harbor indolent cancers that will not threaten their quantity or quality of life.…”

“…5,6 Despite its utility in reducing overtreatment, AS is not without morbidity. 7 The contemporary practice of AS remains largely based upon frequent clinical examination, serum prostate-specific antigen (PSA) testing, and prostate biopsy, 8 a procedure associated with patient discomfort and serious complications including infection. 9,10 Furthermore, these methods lack sensitivity for detection of higher-risk disease, as evidenced by the substantial proportion of men meeting AS criteria who demonstrate high-risk features at radical prostatectomy.…”

Active Surveillance in Prostate Cancer

“…"Cancer of the Prostate Strategic Urologic Research Endeavor" datasının kullanıldığı farklı çalışmalarda, ABD'de 2000'li yılların başında %6,2 oranında Aİ tercih edilirken, 2006'da %10, 2010-2013 döneminde ise bu oran düşük riskli tümörlerde %40'lara kadar yükselmiştir. Yetmiş beş yaş üzeri hastalarda ise %76,2 olarak bildirilmiştir (2). Buna karşın 2014 yılında Japonya'da yapılan bir araştırmada ürologların %26,9'unun hiç tercih etmediği; %50,6'sının ise %5'ten az oranda Aİ tercih ettiği bildirilmiştir (3).…”

When no treatment is the best treatment: Active surveillance strategies for low risk prostate cancers

“…However, there are varying degrees of flexibility. Unsurprisingly, stringent monitoring and lower disease reclassification thresholds are associated with higher intervention rates [26].…”