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Active surveillance for intermediate-risk prostate cancer

Prostate Cancer and Prostatic Diseases volume 20, pages 1–6 (2017)Cite this article

Subjects

Abstract

Background:

Utilization of active surveillance (AS) for prostate cancer is increasing. Optimal selection criteria for this approach are undefined and questions remain on how best to expand inclusion beyond typical men with very low- or low-risk disease. We sought to review the current experience with AS for men with intermediate-risk features

Methods:

PubMed was queried for all relevant original publications describing outcomes for men with prostate cancer managed with AS. Outcomes for patients with intermediate-risk features as defined by the primary investigators were studied when available and compared with similar risk men undergoing immediate treatment.

Results:

Cancer-specific survival for men managed initially with AS is similar to results published with immediate radical intervention. A total of five published AS series describe some outcomes for men with intermediate-risk features. Definitions of intermediate risk vary between studies. Men with Gleason 7 disease experience higher rates of clinical progression and are more likely to undergo treatment over time. Intermediate-risk men with Gleason 6 disease have similar outcomes to low-risk men. Men with Gleason 7 disease appear at higher risk for metastatic disease. Novel technologies including imaging and biomarkers may assist with patient selection and disease surveillance.

Conclusions:

The contemporary experiences of AS for men with intermediate-risk features suggest that although these men are at higher risk for eventual prostate-directed treatment, some are not significantly compromising chances for longer-term cure. Men with more than minimal Gleason pattern 4, however, must be carefully selected and surveyed for early signs of progression and may be at increased risk of metastases. Incorporating information from advanced imaging and biomarker technology will likely individualize future treatment decisions while improving overall surveillance strategies.

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Author information

Authors and Affiliations

  1. Department of Urology, University of California,

    M A Dall'Era

  2. , Davis, Sacramento, CA, USA

    M A Dall'Era

  3. Division of Urology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada

    L Klotz

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Correspondence to M A Dall'Era.

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Competing interests

Dr Dall’Era has received compensation from Genomic Health for his roles as advisor and speaker. Dr Klotz declares no conflict of interest.

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Dall'Era, M., Klotz, L. Active surveillance for intermediate-risk prostate cancer. Prostate Cancer Prostatic Dis 20, 1–6 (2017). https://doi.org/10.1038/pcan.2016.51

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