Active Surveillance Effective for Low-Risk Prostate Cancer - EMJ

Active Surveillance Effective for Low-Risk Prostate Cancer

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ACTIVE surveillance is an effective management strategy for males with favourable-risk prostate cancer, according to recent findings.  

The Canary Prostate Active Surveillance Study (PASS), initiated in 2008, tracked 2,155 males across 10 North American centres, providing crucial data to aid decision-making for patients and healthcare providers. The study specifically focused on males with localised prostate cancer who had not undergone prior treatment. These participants, with a median age of 63 years, and predominantly diagnosed with Grade group 1 cancer, were monitored for a median period of 7.2 years. The median prostate-specific antigen (PSA) level at diagnosis was 5.2 ng/mL.  

Key findings from the PASS cohort indicate that, 10 years post-diagnosis, 49% of patients remained free of cancer progression or need for treatment. The cumulative incidence of biopsy grade reclassification and treatment within this period were 43% (95% confidence interval [CI]: 40–45%) and 49% (95% CI: 47–52%), respectively. Importantly, progression to metastatic cancer was rare, occurring in only 21 participants, and there were just three deaths attributed to prostate cancer. 

The study also revealed that the timing of treatment following initial or subsequent surveillance biopsies did not adversely affect outcomes. Among the males who eventually required treatment, the median time to intervention was 1.5 years after confirmatory biopsy and 4.6 years after subsequent surveillance biopsies. The 5-year recurrence rates post-treatment were 11% (95% CI: 7–15%) and 8% (95% CI: 5–11%) for these groups, respectively. 

Notably, the 10-year metastasis rate stood at 1.4%, and prostate cancer-specific mortality was remarkably low at 0.1%. Overall mortality for the cohort was 5.1% within the same timeframe, underscoring the relatively low risk associated with favourable-risk prostate cancer when managed through active surveillance. 

These results underscore the effectiveness of active surveillance, highlighting it as a safe and reliable option for managing patients with favourable-risk prostate cancer. The study’s findings are expected to play a pivotal role in guiding treatment decisions, providing reassurance to patients opting for active surveillance over immediate intervention. This approach not only helps in avoiding overtreatment but also maintains a high quality of life without compromising long-term health outcomes. 



Newcomb et al. Long-term outcomes in patients using protocol-directed active surveillance for prostate cancer. JAMA. 2024; DOI:10.1001/jama.2024.6695.  

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