Active surveillance for low-risk prostate cancer offers a safe alternative to immediate curative intervention and may reduce overtreatment and adverse events, investigators in a large clinical study concluded. A third of 769 patients eventually had surgery or radiation therapy, but delaying intervention for as long as 10 years caused no apparent harm.
The cohort had a median survival free of intervention of 6.5 years, and the 10-year intervention-free survival was 41% in study participants, who had a median age of 66 at diagnosis, according to an article published online in the Journal of Clinical Oncology. "This study offers the most conclusive evidence to date that active surveillance may be the preferred option for the vast majority of older men diagnosed with a very low-grade or small-volume form of prostate cancer," senior author H. Ballentine Carter, MD, of Johns Hopkins, said in a statement. "These are men with a favorable-risk disease profile to begin with."
Since widespread use of PSA screening for prostate cancer began in the 1990s, disease stage at diagnosis has declined dramatically, such that the majority of newly diagnosed prostate cancers are low risk. Although highly successful, PSA screening has sparked controversy about the potential for overdiagnosis and overtreatment of clinically trivial disease that would not become life-threatening in a man's lifetime (J Natl Cancer Inst 2003; 95: 868-878)