Active surveillance as safe as surgery
Active surveillance is a safe choice for men who are diagnosed with localised prostate cancer, according to a recent study.
After at least 12 years of follow-up, results from the PIVOT trial, published in The New England Journal of Medicine (2017;377:132–42), show no difference in all cause mortality (HR 0.84; [CI] 0.70–1.01; p=0.06) or prostate-cancer specific mortality (HR 0.63; [CI] 0.39–1.02; p=0.06) between observation or prostatectomy for men with localised prostate cancer.
Disease progression was more common for men under observation, although most progression was local and in half of the cases asymptomatic. Side-effects associated with treatment were greater for surgery then observation, with some effects, such as incontinence, still occurring up to 10 years after treatment.
Although not statistically significant, there was a trend to decreased mortality for men who received prostatectomy. Subgroup analyses suggested that surgery might reduce mortality among men with higher PSA values and possibly among men with higher-risk tumors, but not among men with PSA levels of 10 ng per ml or less, or among men with low-risk tumours.
Study results are consistent with the UK-based PROTECT trial, which showed that after a 10 year follow-up, mortality was the same for men treated with active surveillance, prostatectomy or radiotherapy.