Article

Active surveillance for favorable risk prostate cancer: what are the results, and how safe is it?

Department of Surgery, Division of Urology, University of Toronto, Sunnybrook Health Sciences Centre, 2075 Bayview Avenue, Toronto, Ontario, Canada.
Seminars in Radiation Onchology (impact factor: 4.03). 02/2008; 18(1):2-6. DOI:10.1016/j.semradonc.2007.09.001
Source: PubMed

ABSTRACT Active surveillance for favorable risk prostate cancer has become increasingly popular in populations in which prostate cancer screening is widespread because of evidence that prostate cancer screening results in the detection of disease that is not clinically significant in many patients (ie, untreated, would not pose a threat to health). The approach is supported by data showing that patients who fall into the category of clinically insignificant disease can be identified with reasonable accuracy and that patients who are initially classified as low risk who reclassify over time as higher risk and are treated radically are still cured in most cases. This means (1) identifying patients who have a low likelihood of disease progression during their lifetime based on clinical and pathologic features of the disease and patient age and comorbidity, (2) close monitoring over time, (3) reasonable criteria for intervention that will both identify more aggressive disease in a timely fashion and not result in excessive treatment, and (4) meeting the communication challenge to reduce the psychological burden of living with untreated cancer. The results of active surveillance, the criteria for patient selection, and the appropriate triggers for intervention are reviewed.

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    Article: ESUR prostate MR guidelines 2012.
    Jelle O Barentsz, Jonathan Richenberg, Richard Clements, Peter Choyke, Sadhna Verma, Geert Villeirs, Olivier Rouviere, Vibeke Logager, Jurgen J Fütterer
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    Dataset: lawrentschuk klotz Active surveillance prostate cancer Nature Reviews Urology
    Nathan Lawrentschuk, Laurence Klotz
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    Article: Active surveillance for low-risk prostate cancer: an update.
    Nathan Lawrentschuk, Laurence Klotz
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    ABSTRACT: Active surveillance is now an accepted management strategy for men with low-risk localized prostate cancer, in recognition of the knowledge that the majority of men with such cancers are likely to die from other causes. The most obvious benefit of active surveillance is the reduction of morbidity associated with surgery by delaying or avoiding radical gland therapy. Other advantages include lower overall costs to the health-care system and potentially a better quality of life. These advantages should be balanced against the risks of delayed therapy, the most considerable of which being development of more-aggressive disease. Appropriate selection criteria and the definition of triggers for intervention with radical therapy are critical components of an active surveillance protocol. The ability to accurately identify and cure the men whose cancers will progress using clinical, biopsy and imaging data is yet to be resolved, as is the psychological burden of living with an untreated cancer. The benefit of 5α-reductase inhibitors as secondary chemoprevention in men on active surveillance is a new avenue of research. Focal therapy, which has the similar aim of reducing morbidity while maintaining oncological control, is an emerging competitor for active surveillance. Nevertheless, active surveillance is an appealing management option for selected men with prostate cancer.
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Keywords

active surveillance
 
aggressive disease
 
clinically insignificant disease
 
communication challenge
 
comorbidity
 
criteria
 
disease progression
 
excessive treatment
 
favorable risk prostate cancer
 
low likelihood
 
low risk
 
pathologic features
 
patient selection
 
patients
 
prostate cancer screening
 
prostate cancer screening results
 
psychological burden
 
timely fashion
 
untreated
 
untreated cancer
 

Laurence Klotz