Active surveillance a safe option in low-risk prostate cancer

Active surveillance of patients with low-risk (Grade 1) prostate cancer can keep patients treatment-free for many years, according to a new US study published in The Journal of Urology

In a retrospective evaluation of a large active surveillance cohort, the authors reported a treatment-free survival at 5, 10 and 15 years was 76% (95% CI 74–78), 64% (95% CI 61–68) and 58% (95% CI 51–64), respectively. The risk of distant metastasis was 0.6% (95% CI 0.2-2.0) at 10 years.

2907 patients were evaluated with a median age at diagnosis of 62 years. Active surveillance involved twice yearly PSA tests, digital rectal examination (DRE) and review of symptoms. Magnetic resonance imaging (MRI) was increasingly used towards the end of the study, which ran between 2000 and 2017. Biopsy was repeated every two to three years, or after a sustained PSA increase or changes in MRI/DRE.

Commenting on the study, Michael H. Johnson, Assistant Professor of Urology and Oncology, Johns Hopkins Hospital, Baltimore says: ‘Although active surveillance is a recommended treatment option for low-risk prostate cancer, understanding the risks of needing further treatment or developing metastatic disease is critical for patient counselling. Patients with low-risk prostate cancer should be informed about the low risk of developing metastatic disease, even at 10 to 15 years but need to be aware that safe surveillance requires routine clinical monitoring.’

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