For men diagnosed with low-risk prostate cancer, active surveillance can be a sensible first step in managing the disease.
Mark Solloway and a team of urologists at University of Miami Miller School of Medicine have reported on outcomes for a group of their patients.
In all, 157 men with localized prostate cancer were followed on AS.
Patients were assigned to active surveillance if they met these criteria:
Gleason score of < or = 6
a serum prostate-specific antigen (PSA) level of < or = 15 ng/mL
stage < or = T2
and > 12 months of follow-up.
The follow-up was rigorous, with PSA tests and a digital rectal examination every 3 months for 2 years, and a repeat biopsy 6-12 months after the initial diagnosis and yearly when indicated.
Continuance of AS was based on the PSA doubling time, re-biopsy score, Gleason score, tumor volume, stage progression and patient preference.
In all 99 patients met the inclusion criteria; their mean age at diagnosis was 66 years, their mean PSA level 5.77 ng/mL and the mean follow-up 45.3 months.
On initial repeat biopsy, 63% had no cancer and 34% had a Gleason sum of < or = 6.
Eight patients were treated (three with hormones; five with curative intent); two had radical prostatectomy (one had pT2c pNO Gleason 7 disease); three had radiotherapy.
The probability is that 85% would remain treatment-free at 5 years; no patient died from prostate cancer.
The PSA doubling time and clinical stage at diagnosis were predictive of progression.
Patients who are followed on AS must be selected using narrowly defined inclusion criteria and closely followed with a standard regimen of PSA testing, digital rectal examination and repeat biopsy.
Active surveillance; a reasonable management alternative for patients with prostate cancer: the Miami experience.
Solloway MS,et al. BJU Int.2008 Jan;101(2):165-9. Epub 2007 Sep 10.