Active Surveillance for Prostate Cancer: How to Do It Right

Area of Science:

• Urology
• Oncology
• Men's Health

Background:

• Prostate cancer is the most common male malignancy, with a 70% increase in early-stage diagnoses due to PSA screening.
• Low-grade prostate cancer often has clinical insignificance and minimal metastatic potential.
• Active surveillance offers a conservative management option for low-risk prostate cancer, preserving quality of life by avoiding immediate treatment side effects.

Purpose of the Study:

• To review the rationale and biological evidence for active surveillance in favorable-risk prostate cancer.
• To discuss patient selection criteria, clinical trial data, and the role of biomarkers and MRI in active surveillance decision-making.
• To highlight the long-term safety and oncologic outcomes of active surveillance for prostate cancer.

Main Methods:

• Review of natural history data for low-grade prostate cancer.
• Analysis of D'Amico criteria for active surveillance eligibility (Gleason score ≤6, PSA <10 ng/mL).
• Examination of systematic biopsy findings, molecular alterations, and progression detection in active surveillance cohorts.

Main Results:

• Active surveillance involves close monitoring via digital rectal exams, biopsies, and PSA testing.
• Approximately 30% of patients initially on active surveillance may be diagnosed with higher-risk disease upon systematic biopsy.
• Long-term oncologic outcomes demonstrate the safety of active surveillance, with a 3% cancer-specific mortality rate at 10-15 years.

Conclusions:

• Active surveillance is a viable and safe approach for favorable-risk prostate cancer, preserving quality of life.
• Early detection of disease progression through monitoring and biomarkers is crucial for successful active surveillance.
• The integration of advanced imaging like MRI aids in clinical decision-making for patients undergoing active surveillance.