Active surveillance in men with localized prostate cancer: a systematic review

Area of Science:

• Oncology
• Urology
• Clinical Management

Background:

• Active surveillance (AS) and watchful waiting (WW) are proposed management strategies for low-risk, localized prostate cancer.
• These observational approaches aim to defer or avoid immediate treatment with curative intent.

Purpose of the Study:

• To systematically review observational management strategies (AS or WW) for prostate cancer.
• To identify factors influencing the utilization of AS and WW.
• To compare the effectiveness of observational management versus immediate treatment with curative intent.

Main Methods:

• Systematic review of MEDLINE and Cochrane databases (inception to August 2011).
• Screening of abstracts and full-text publications for eligible studies.
• Data extraction by one reviewer, verification by another; study quality and strength of evidence rated by two independent reviewers.

Main Results:

• Sixteen cohorts defined AS criteria (tumor stage, Gleason score, PSA, biopsy cores).
• Monitoring commonly involved PSA testing, digital rectal exams, and rebiopsies.
• Watchful waiting was generally less effective than curative treatment, but applicability to current patients may be limited.
• No studies directly compared AS with immediate curative treatment.

Conclusions:

• Active surveillance and watchful waiting were often indistinguishable in reviewed studies.
• Published randomized trials focused only on WW and excluded PSA-screened patients.
• Insufficient evidence exists to confirm AS as an appropriate option for localized prostate cancer; a standardized definition is required.