Active surveillance

Results were reported in 2002 on 231 patients with favourable-risk prostate cancer (Gleason score 6 or less, PSA 10 or under) who were part of a prospective phase II trial of active surveillance that began in 1995 at the Sunnybrook Health Sciences Centre in Toronto, Ontario. The present study was based on the second analysis of this group, which now comprises 453 men. The participants, ranging in age from 45 to 86 years, chose active surveillance as an alternative to standard therapy, and were followed with serial PSA testing and periodic biopsy.

At a median follow-up of about seven years, overall survival is 83% and prostate cancer survival is 99% (five out of 453 patients have died of prostate cancer); 35% of the patients have been reclassified as higher risk and offered other treatment (e.g. if their PSA doubling time was less than three years or Gleason score was upgraded). Of the patients who underwent more radical treatments, the PSA failure rate was 52%.

The study authors concluded that active surveillance with delayed intervention (until there are signs of progression) is feasible and is associated with a low rate of prostate cancer-related deaths in the medium term. This strategy offers the advantage of an individualized approach; it may decrease the burden of treatment in men with slow-growing disease, while providing definitive therapy for those with active cancer that progresses over time.