New data showed that from 2010 to 2015, the number of U.S. men with low-risk prostate cancer on active surveillance tripled. In 2015, 42% of men with low-risk prostate cancer were monitoring their disease through active surveillance or watchful waiting, compared to 14.5% in 2010. This sharp increase coincides with timeline of U.S. guidelines recommending increased use of active surveillance for men with low-risk prostate cancer in an effort to avoid overtreatment.
JAMA. 2019 Feb 11. doi: 10.1001/ jama.2018.19941. [Epub ahead of print]
Active Surveillance for Men Younger Than 60
Younger men diagnosed with low-risk prostate cancer are often counseled to undergo definitive treatment for their disease, such as surgery or radiation, rather than practicing active surveillance. A new retrospective study examined medical records of more than 2,000 men and compared rates of disease progression in men who began active surveillance before or after turning 60 years old. The median follow-up was about six years.
Dr. Catalona's Opinion
In general, prostate cancer is less aggressive in younger men because it usually has not been present as long and therefore the tumor burden is less, and the opportunity for additional genetic mutations is less. Therefore, one would expect young patients to fare well in the short-term with active surveillance. However, younger men have a longer life time horizon and therefore a longer opportunity to develop metastases, suffer, and die from prostate cancer, so the long-term outcomes might be worse in younger men. Further accurate follow-up information is needed to draw a firm conclusion.
The two groups had similar rates of progression-free survival after five years, as well as treatment-free survival, metastasisfree survival, and prostate cancer specific survival.
In men younger than 60 on active surveillance, 31% ultimately had definitive treatment based on disease progression as indicated by biopsy or elevated PSA. Men in the younger group were more likely to have disease progression on biopsy or later elect definitive treatment if their initial diagnosis had 20% or greater involvement of cancer on any core, or if their PSA density was .15/ng/ml/ml or higher.
J Urol. 2019 Apr;201(4):721-727. doi: 10.1097/JU.0000000000000031