Reasons Men Discontinue Active Surveillance

Active surveillance (AS) is a management option for patients with favorable-risk prostate cancer. Drs. Stacy Loeb, M.D., of New York University, Pär Stattin, from the National Prostate Cancer Register of Sweden, and their colleagues reported on data from 11,726 men aged 70 years or younger in the Swedish registry. The men were diagnosed with very low-risk to intermediate-risk prostate cancer. Fifteen percent of these men had chosen AS as their primary management strategy. After 5 years, 36% had withdrawn from AS management. Among men with very low-risk, low-risk, and intermediate- risk disease, 35%, 33%, and 41%, respectively, discontinued AS.

The reasons for discontinuation were patient preference (20%), evidence of a rising PSA (52%), tumor progression on surveillance biopsies (24%), and other reasons (3%). In men who withdrew from AS because of PSA progression, the median PSA level was 6.3 ng/mL at diagnosis and 9.8 ng/mL at discontinuation. Sixty- eight percent of the men underwent radical prostatectomy and 32% received radiation therapy.

Younger men were less likely to remain on AS. As compared with men younger than 60, men aged 65-70 years were 31% less likely to withdraw from AS. Men with tumors that could be felt by the physician on rectal examination were 63% more likely to discontinue AS than those with tumors that could not be felt. Men with a high level of education were also less likely to remain on AS.

The authors cautioned that data from Swedish men may not apply to other populations with different healthcare systems and cultural backgrounds.