Outcomes and follow-up strategies for patients on active surveillance

Prostate cancer is now the most commonly diagnosed solid tumor in American men. Autopsy studies show the uniquely high prevalence rates of small, indolent tumors in men dying of other causes. These findings have led to an increased interest in managing men with prostate cancer and low risk features expectantly, with close observation for early signs of progression. This approach allows one to limit prostate cancer treatment and any risk of related morbidity to the men who will benefit the most from active intervention.

Several centers have published their results with active surveillance and delayed selective therapy for men with low grade, early prostate cancer. Although median follow up from these studies is relatively short, the outcomes appear favorable. About one third of men will receive treatment after 3-5 years of surveillance and quality of life remains high.

Data from these reports provide patients and clinicians with the early experiences and expectations with active surveillance for prostate cancer. They also provide a framework for selecting men for this approach and for following them over time. Prospective, randomized trials comparing active surveillance with standard interventions are underway.