Has Active Surveillance for Prostate Cancer Become Safer? Lessons Learned from a Global Clinical Registry

Area of Science:

• Oncology
• Urology
• Public Health

Background:

• Active surveillance (AS) is a common management strategy for low- and intermediate-risk prostate cancer.
• Long-term safety and outcomes data for AS are crucial for guiding clinical practice.

Purpose of the Study:

• To evaluate the long-term safety, acceptability, and treatment outcomes of active surveillance for prostate cancer.
• To analyze survival rates and treatment progression in a large international cohort.

Main Methods:

• Analysis of clinical data from 26,999 men on AS across 25 cohorts in 15 countries.
• Data collected in an international database from 2000 onwards, with follow-up exceeding 6 years.

Main Results:

• No significant change in overall survival (OS) over time.
• Metastasis-free survival (MFS) rates improved and remained excellent (>99%).
• 10-year overall survival was 84.1% and metastasis-free survival was 99.4%.

Conclusions:

• Active surveillance is a safe management option for low- and intermediate-risk prostate cancer with excellent long-term outcomes.
• New diagnostic tools could enhance AS acceptability and potentially expand its use to higher-risk cases.
• Treatment was initiated in 20% of low-risk and 31% of intermediate-risk cases by 10 years.