Long-Term Results of Active Surveillance Raise Questions
Included in AUA Prostate Cancer Update Course* The Göteborg Prostate Cancer Screening Trial is a randomized, population-based European study. Recent results assessed the long-term safety of active surveillance (AS) for men with prostate cancer detected through a screening program.
The study included 474 men on AS with very low-risk, low-risk, and intermediate-risk prostate cancer. More than 200 men in the study (42%) discontinued AS and started treatment for prostate cancer.
When compared to men with very low-risk prostate cancer, men with low-risk prostate cancer were 2.2 times more likely to fail AS, and men with intermediate-risk prostate cancer were 4.8 times more likely to fail AS. The treatment-free survival rate was 47% at 10 years and 34% at 15 years.
The men had repeat PSA tests every 3-12 months and repeat biopsies in cases of clinical progression or every 2-3 years in men with stable disease. The triggers for starting treatment were disease progression (in PSA, grade, and/or stage) or if the patient elected to initiate treatment.
The authors concluded that “some men will miss their chance of cure with active surveillance and it is questionable whether active surveillance is a suitable strategy for men who are not in the lowest tumor risk group and who have a very long remaining life expectancy.”
Eur Urol. 2016 Apr 15. pii: S0302-2838(16)30026-4. doi: 10.1016/j.eururo.2016.03.048. [Epub ahead of print]
*Dr. Catalona’s Prostate Cancer Update Course
Dr. Catalona led the Prostate Cancer Update course at the American Urological Association annual meeting. The course highlighted important findings on prostate cancer published during the last year. The topics are wide-ranging. This issue of QUEST covers some of these articles, which we hope will be of interest to our readers.