Active Surveillance

Active surveillance — in which prostate cancer is regularly monitored for signs of progression — spares men whose tumors may never progress from potential treatment-associated adverse effects, such as sexual dysfunction or incontinence. Proponents contend active surveillance is a viable option because mortality rates among men whose tumors are limited to the prostate are low, and many of these men never experience symptoms from their disease. However, some urologic oncologists question active surveillance as a standard management strategy and contend its use should be limited. Read the article.

Men receiving active surveillance were 24 times more likely to die from causes other than prostate cancer over 15 years. Caucasian men with favorable-risk prostate cancer who opt for active surveillance have a low risk of progression to lethal cancer for a decade after diagnosis, according to researchers. Read the article.

Men with low-risk prostate cancer on active surveillance whose tumors are upgraded after a biopsy might not have to rush into surgery, according to new research. The men in this study had localized low-risk prostate cancer — a Gleason score of 3 + 3 or lower and a clinical stage of T1 or T2. All had a tumor upgrade while being managed with active surveillance The majority of the men who chose to remain on active surveillance after a tumor upgrade, rather than undergo immediate treatment, had no further progression of tumor grade. Read the article.

Active surveillance for men with low-risk prostate cancer reduces overtreatment, but it could also mean that some men miss the opportunity for cure, according to the Göteborg randomized population-based prostate cancer screening trial. Read the article. (Needs free MedScape login.)

Prostate cancer (PCa) patients with a tumour grade of Gleason 6 or less at the time of radical prostatectomy (RP) are extremely unlikely to progress to metastatic disease or die from their cancer, according to a new study published online ahead of print in BJU International. Read the article.

The percentage of prostate cancer with low-risk characteristics has increased since the mid-1990s largely due to widespread prostate-specific antigen (PSA) screening. Over a similar period, the percentage of prostate cancer mortalities has reduced by more than 40%. There is now growing evidence that men with low-risk prostate cancer may not benefit from radical treatment. This has created controversy regarding PSA screening practices and the treatment of low-risk prostate cancer due to concerns of overdiagnosis and overtreatment. Active surveillance (AS) is an accepted alternative to immediate intervention for favourable-risk prostate cancer and it has shown promise in reducing overtreatment. Several large

The rate of reclassification during surveillance is not equally distributed across time or risk groups. Due to misclassification at the time of diagnosis, the rates of reclassification between very-low-risk and low-risk groups are similar within the first two years but differ significantly beyond two years. The risk of reclassification falls over time with each non-reclassifying biopsy beyond two years. Read the article.