Active surveillance for prostate cancer

Daniela K. Shill, Monique J. Roobol, Behfar Ehdaie, Andrew J. Vickers, Sigrid V. Carlsson*

*Corresponding author for this work

Research output: Contribution to journalReview articleAcademicpeer-review

30 Citations (Scopus)
48 Downloads (Pure)

Abstract

Many men diagnosed with localized prostate cancer can postpone definitive treatment without raising their risk of metastasis or death from disease. Active surveillance (AS) is a method of monitoring select men, with the option of switching to active treatment upon signs of progression, thereby avoiding the well-known side-effects of surgery and radiotherapy. This review analyzes the data from long-running AS cohorts to determine the safety and efficacy of AS. We conducted a narrative review of recently published data, including 14 articles from 13 AS cohorts. The cohorts used varying inclusion criteria, with reported differences in clinical T stage and Gleason Score (Grade Group), among other features. Some studies (n=5) limited their cohorts to low-risk patients, while others (n=8) also included intermediate-risk patients. The heterogeneity of the cohorts produced mixed results, with the risk of prostate cancer metastasis ranging from 0.1-1.0% at 10 years and the risk of prostate cancer mortality ranging from 0-1.9% at 10 years. However, the majority of studies reported risks of less than 0.5% at 10 years for both metastasis and death. For most cohorts, half of men remained untreated for 5-10 years, with estimates ranging from 37% receiving active treatment in the Toronto cohort to 73% in the Prostate Cancer Research International AS (PRIAS) study. Current data do not support the use of negative magnetic resonance imaging (MRI) to avoid scheduled biopsy. Taken together, the data collected from these AS cohorts suggests that AS is a safe approach for men with low-grade prostate cancer and some men with intermediate risk disease. AS should be more broadly implemented for eligible patients to avoid the decreases in quality of life from undergoing active treatment. Studies expanding the inclusion criteria and further defining a subset of men with favorable intermediate-risk prostate cancer who might safely benefit from AS are needed to assess the long-term outcomes of using AS in intermediate-risk groups.

Original languageEnglish
Pages (from-to)2809-2819
Number of pages11
JournalTranslational Andrology and Urology
Volume10
Issue number6
DOIs
Publication statusPublished - Jun 2021

Bibliographical note

Funding Information:
MLIS for assistance with the literature search and Dr. Laura Liberman, Office of Faculty Development, Memorial Sloan Kettering Cancer Center, New York, USA, for the 2020 Summer Clinical Oncology Research Experience (SCORE) Program that enabled DKS's work on this study. Funding: SVC's, AJV's and BE's work on this paper was supported in part by funding from the National Institutes of Health/National Cancer Institute (P30-CA008748) and the Sidney Kimmel Center for Prostate and Urologic Cancers. SVC was further supported by a career development award from the National Institutes of Health/National Cancer Institute (K22-CA234400) and U01-CA1999338-02. The funding bodies had no role in the preparation, review, or approval of the manuscript or the decision to submit the manuscript for publication.

Publisher Copyright:
© Translational Andrology and Urology. All rights reserved.

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