Men's Health

Effectiveness of active surveillance for men with localized prostate cancer is unclear

Active surveillance (AS) is an observational strategy that involves forgoing immediate therapy for patients with low-risk localized prostate cancer. A systematic review of the literature on AS has concluded that evidence is insufficient to assess the comparative effectiveness of AS versus immediate active treatment for these men. The authors also reviewed other observational strategies, including watchful waiting (WW), to determine the factors affecting their use. AS is appropriate for men with disease that is believed to be indolent who do not require immediate therapy. Men on AS are followed regularly with clinical, laboratory, and biopsy monitoring.
Monitoring parameters are used to determine when curative treatments should be considered. On the other hand, WW is a more passive strategy with interventions—often palliative—triggered largely by symptomatic progression. It is usually reserved for older men with localized cancer or major coexisting conditions who are not likely to benefit from curative treatments. The authors found that patients for whom AS was considered appropriate were most commonly selected on the basis of the following criteria: tumor stage, Gleason score, prostate-specific antigen concentration, and number of biopsy cores testing positive for cancer.
The reviewers also found that studies of factors influencing the implementation of observational management strategies were hampered by the lack of clear definitions of these strategies and the limited information available in existing data sets. Evidence on the comparative effectiveness of AS to immediate clinical treatment was lacking. The Agency for Healthcare Research and Quality funded this review (Contract No. 290-07-10055).
See "Active surveillance in men with localized prostate cancer. A systematic review," by Issa J. Dahabreh, M.D., Mei Chung, Ph.D., Ethan M. Balk, M.D., and others in the April 2012 Annals of Internal Medicine 156, pp. 582-590.

— MWS