Observational studies and the natural history of screen-detected prostate cancer

To review the recent observational studies and clinical trials that guide our understanding of the natural history of screen-detected prostate cancer.

Data from observational studies and clinical trials have been updated during the past year. The most important include the Scandinavian Prostate Cancer Group 4 study and the European Randomized Study of Prostate Cancer Screening.

Both retrospective population-based analyses and prospective randomized trials show that men who harbor low-volume low-grade prostate cancers have less than 6% risk of disease progression within a decade of diagnosis. For the men who pursue active surveillance prostate cancer mortality remains under 1% after a median follow-up of 6.8 years. Up to one-third of men abandon active surveillance protocols because of either prostate-specific antigen or biopsy progression. Around 10% abandon active surveillance because of anxiety. Researchers are actively exploring new imaging modalities and genetic markers to identify men whose prostate cancers are likely to progress. For now, patients with newly diagnosed prostate cancer must carefully weigh the threat posed by their disease against the possible benefits and harms associated with intervention. For some, active surveillance will be an appropriate choice.