Active Surveillance For Early Stage Prostate Cancer: Review Of The Current Literature

Main Category: Prostate / Prostate Cancer
Also Included In: Urology / Nephrology
Article Date: 30 May 2008 - 0:00 PDT

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UroToday.com - In the online version of Cancer, Dr. Dall'Era and colleagues provide a comprehensive overview of active surveillance (AS) for prostate cancer (CaP). The rationale for AS is that many men are diagnosed with CaP with a 12-year lead time and almost 8 times as many men are diagnosed with CaP yearly as will die of it. Data suggests that AS with delayed intervention if necessary does not put the properly selected patient at risk for disease progression.

The most common criteria used to select patients for AS are a Gleason Score of 6 or less, PSA <10ng/ml, and clinical stage T1cT2a CAP. Additional characteristics considered by some include PSA density <0.15, <33% positive biopsy cores and extent of CaP in any core of <50%, with stable PSA kinetics prior to diagnosis. The criteria to follow patients vary, but Carter described a PSA and DRE every 6 months with an annual prostate biopsy. Others describe checking PSA every 3 months, with a repeat prostate biopsy at one year. Using a grade progression to Gleason 4+3 or greater on re-biopsy only led to 4% of men being treated due to grade progression. A PSA doubling time on <3 years is the more common trigger to provide treatment intervention. This resulted in 21% of men converting to treatment.

Follow-up data are limited, but data suggests that 20-33% of men on AS will convert to active therapy. CaP specific deaths are rare. However up to half of men on AS come off and seek treatment without evidence of progression due to their concerns about disease status. Anxiety is common in these men and may exceed grade or biopsy progression as prompting men to have active treatment.

Despite the number of men who qualify for AS, few choose it. From 2000 to 2006 the percent of men electing AS for their CaP increased only from 6.2% to 10.2%.

Reported by UroToday.com Contributing Editor Christopher P. Evans, MD, FACS

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