For selected men with very low-risk prostate cancer, active surveillance appears to be safe and allows men to avoid or delay treatment with surgery or radiation therapy. These results were published in the Journal of Clinical Oncology.
Men with early-stage prostate cancer have the option of being treated aggressively, which may include radiation therapy or surgery to remove the prostate (radical prostatectomy), or conservatively, which may involve no therapy until the cancer shows signs of worsening (active surveillance). The choice of treatment can be difficult; for men with low-risk prostate cancer, there is no clear proof that early treatment prolongs survival compared with treatment that is deferred until there is evidence of disease progression. Active surveillance may help some men avoid unnecessary treatment and potentially long-lasting side effects.
To assess outcomes after active surveillance, researchers collected information about 769 men who were patients at Johns Hopkins and chose active surveillance. Half the men were over the age of 66. On the basis of stage, prostate-specific antigen (PSA) density, and biopsy findings, most of the men were considered to have very low-risk prostate cancer. The men received regular follow-up that included annual prostate biopsies; curative treatment was recommended if a follow-up biopsy suggested higher-risk disease. Curative treatment was also an option if the men simply changed their minds about remaining on active surveillance.
Study participants were followed for up to 15 years (median follow-up was 2.7 years).
- At the time of the analysis, 54% of the men were still on active surveillance, 33% had undergone curative treatment (surgery or radiation therapy), 11% had withdrawn from the study or were lost to follow-up, and 2% had died of causes other than prostate cancer.
- The probability of remaining on active surveillance was 81% after two years, 59% after five years, and 41% after 10 years.
- Men who had the lowest-risk cancer at the time of diagnosis were less likely than other men to eventually require surgery or radiation therapy.
- None of the men developed distant metastases, and there were no prostate cancer deaths.
The researchers conclude “For carefully selected men, active surveillance with curative intent appears to be a safe alternative to immediate intervention. Limiting surveillance to very-low-risk patients may reduce the frequency of adverse outcomes.”
Reference: Tosoian JJ, Trock BJ, Landis P et al. Active surveillance program for prostate cancer: an update of the Johns Hopkins experience. Journal of Clinical Oncology. Early online publication April 4, 2011.