Active Surveillance vs. Radical Treatment of Prostate Cancer
Posted: Wednesday, March 6, 2019
Although the decision between radical treatment and active surveillance for men with prostate cancer lacks quality evidence, active surveillance may provide a better quality of life. A review published in the World Journal of Urology by Luke Witherspoon, MD, of the University of Ottawa, Canada, and colleagues analyzes eligibility, protocols, and prognosis for men on active surveillance for prostate cancer, highlighting the limitations of current data.
In terms of eligibility for active surveillance, the authors noted there have been no randomized studies comparing criteria for surveillance. All studies thus far have been observational and do not seem to agree on the standards by which patients are deemed candidates for surveillance, leaving the decision to individual physicians and patients.
Patients choosing active surveillance are often monitored with digital rectal exam and prostate-specific antigen testing, with many protocols also recommending additional biopsies every 2 to 5 years. There is no consensus as to when patients should switch from surveillance to radical treatment, and the authors suggested that this decision also should be patient-specific. However, there is indirect evidence showing that magnetic resonance imaging (MRI) improves the detection of clinically significant prostate cancer on initial biopsy. In addition, MRI may help to monitor disease progression and aid in decision-making, although there are no high-quality data on prostate MRI.
Data from the randomized ProtecT trial showed that men initiating active monitoring have similar survival outcomes as those undergoing radical treatment, but 50% of those in active surveillance receive radical treatment within 10 years. Men with low-volume disease can often remain in active surveillance for a time but may have a higher risk of metastasis.
Active surveillance is related to a better quality of life, with 4% of men experiencing urinary incontinence as compared with 46% of men who underwent radical therapy. Erectile function and bowel function were both considerably better for patients on active surveillance.
Disclosure: The study authors’ disclosure information may be found at springer.com.