According to the conclusions of a National Institutes of Health (NIH) State-of-the-Science Conference, active surveillance is a viable option for the management of low-risk prostate cancer.

Prostate cancer is the most commonly diagnosed cancer (other than skin cancer) in US men. In 2012, roughly 240,000 men are expected to be diagnosed with the condition.

The management of early prostate cancer may involve surgery, radiation therapy, or active surveillance (close observation and testing but no treatment until the cancer shows signs of worsening). Because not all prostate cancers are life-threatening, active surveillance allows some men to avoid (or at least delay) the side effects that accompany surgery and radiation therapy.

Studies have suggested that for men with low-risk prostate cancer, survival with active surveillance is comparable to survival with immediate cancer treatment. Low-risk prostate cancers are those that are small, have a low Gleason Score, and occur in a man with fairly low prostate-specific antigen (PSA) levels. Many men may be reluctant, however, to defer cancer treatment.

To provide some guidance about active surveillance, the National Institutes of Health convened a State-of-the-Science Conference. The conference brought together an independent panel of experts to review, discuss, and summarize the available information on the topic.

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In a draft statement, the panel concluded “Because of the very favorable prognosis of low-risk prostate cancer, strong consideration should be given to removing the anxiety-provoking term “cancer” for this condition. Treatment of low-risk prostate cancer patients with radical prostatectomy or radiation therapy leads to side effects such as impotence and incontinence in a substantial number. Active surveillance has emerged as a viable option that should be offered to patients with low-risk prostate cancer.”

The panel also outlined additional research that is necessary in this area. Topics included the identification of candidates for active surveillance, the optimal protocol for active surveillance, and how best to communicate the option of active surveillance to patients. Additional information about short- and long-term outcomes with active surveillance is also needed.

Reference: National Institutes of Health State-of-the-Science Conference: Role of active surveillance in the management of men with localized prostate cancer. Draft statement, December 7, 2011.

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