Current Urology Reports

, Volume 11, Issue 3, pp 165–171

Active Surveillance for Prostate Cancer: A Review

Article

Abstract

Active surveillance is a solution to the widely acknowledged problem of overdiagnosis and overtreatment of clinically insignificant disease which accompanies early detection of prostate cancer using prostate-specific antigen (PSA) and biopsy. It is an approach to the management of favorable-risk prostate cancer which uses the opportunity provided by the long natural history of the disease to incorporate a period of initial observation into patient management. The basic concept is that most men diagnosed with low-grade, small-volume disease are not destined to have any clinical manifestations of the condition during their lifetime. However, a subset of patients with favorable-risk prostate cancer is at risk, due to either the presence of higher-risk disease not apparent at diagnosis or progression to a more aggressive phenotype over time. These patients can be identified with reasonable accuracy by close follow-up, including serial PSAs and biopsies, and treated effectively in most cases. The rationale, patient selection, method of follow-up, triggers for intervention, and recent results of this approach will be reviewed.

Keywords

Prostate cancer Active surveillance Low risk PSA kinetics Review 

References

  1. 1.
    Schröder FH, Hugosson J, Roobol MJ, et al.; ERSPC Investigators: Screening and prostate-cancer mortality in a randomized European study. N Engl J Med 2009, 360:1320–1328.CrossRefPubMedGoogle Scholar
  2. 2.
    Roobol MJ, Kerkhof M, Schröder FH, et al.: Prostate cancer mortality reduction by prostate-specific antigen-based screening adjusted for nonattendance and contamination in the European Randomised Study of Screening for Prostate Cancer (ERSPC). Eur Urol 2009, 56:584–591.CrossRefPubMedGoogle Scholar
  3. 3.
    Jemal A, Siegel R, Ward E, et al.: Cancer statistics, 2009. CA Cancer J Clin 2009, 59:225–249.CrossRefPubMedGoogle Scholar
  4. 4.
    Sakr WA, Haas GP, Cassin BF, et al.: The frequency of carcinoma and intraepithelial neoplasia of the prostate in young male patients. J Urol 1993, 150:379–385.PubMedGoogle Scholar
  5. 5.
    Welch HG, Albertsen PC: Prostate cancer diagnosis and treatment after the introduction of prostate-specific antigen screening: 1986–2005. J Natl Cancer Inst 2009, 101:1325–1329.CrossRefPubMedGoogle Scholar
  6. 6.
    Presti JC Jr: Prostate biopsy: how many cores are enough? Urol Oncol 2003, 21:135–140.PubMedGoogle Scholar
  7. 7.
    D’Amico AV, Whittington R, Malkowicz SB, et al.: Biochemical outcome after radical prostatectomy or external beam radiation therapy for patients with clinically localized prostate carcinoma in the prostate specific antigen era. Cancer 2002, 95:281–286.CrossRefPubMedGoogle Scholar
  8. 8.
    Cooperberg MR, Broering JM, Kantoff PW, Carroll PR: Contemporary trends in low risk prostate cancer: risk assessment and treatment. J Urol 2007, 178:S14–S19.CrossRefPubMedGoogle Scholar
  9. 9.
    Albertsen PC, Hanley JA, Fine J: 20-year outcomes following conservative management of clinically localized prostate cancer. JAMA 2005, 293:2095–2101.CrossRefPubMedGoogle Scholar
  10. 10.
    Albertsen PC, Hanley JA, Barrows GH, et al.: Prostate cancer and the Will Rogers phenomenon. J Natl Cancer Inst 2005, 97:1248–1253.PubMedCrossRefGoogle Scholar
  11. 11.
    Draisma G, Boer R, Otto SJ, et al.: Lead times and overdetection due to prostate-specific antigen screening: estimates from the European Randomized Study of Screening for Prostate Cancer. J Natl Cancer Inst 2003, 95:868–878.PubMedGoogle Scholar
  12. 12.
    Törnblom M, Eriksson H, Franzén S, et al.: Lead time associated with screening for prostate cancer. Int J Cancer 2004, 108:122–129.CrossRefPubMedGoogle Scholar
  13. 13.
    Bill-Axelson A, Holmberg L, Ruutu M, et al.; Scandinavian Prostate Cancer Group Study No. 4: Radical prostatectomy versus watchful waiting in early prostate cancer. N Engl J Med 2005, 352:1977–1984.CrossRefPubMedGoogle Scholar
  14. 14.
    Choo R, Klotz L, Danjoux C, et al.: Feasibility study: watchful waiting for localized low to intermediate grade prostate carcinoma with selective delayed intervention based on prostate specific antigen, histological and/or clinical progression. J Urol 2002, 167:1664–1669.CrossRefPubMedGoogle Scholar
  15. 15.
    Klotz L, Zhang L, Lam A, et al.: Clinical results of long-term follow-up of a large, active surveillance cohort with localized prostate cancer. J Clin Oncol 2010, 28:126–131.CrossRefPubMedGoogle Scholar
  16. 16.
    Khatami A, Aus G, Damber JE, et al.: PSA doubling time predicts the outcome after active surveillance in screening-detected prostate cancer: results from the European randomized study of screening for prostate cancer, Sweden section. Int J Cancer 2007, 120:170–174.CrossRefPubMedGoogle Scholar
  17. 17.
    Soloway MS, Soloway CT, Williams S, et al.: Active surveillance; a reasonable management alternative for patients with prostate cancer: the Miami experience. BJU Int 2008, 101:165–169.PubMedGoogle Scholar
  18. 18.
    Carter HB, Kettermann A, Warlick C, et al.: Expectant management of prostate cancer with curative intent: an update of the Johns Hopkins experience. J Urol 2007, 178:2359–2364.CrossRefPubMedGoogle Scholar
  19. 19.
    Parker C: Active surveillance: towards a new paradigm in the management of early prostate cancer. Lancet Oncol 2004, 5:101–106.CrossRefPubMedGoogle Scholar
  20. 20.
    van As NJ, Parker CC: Active surveillance with selective radical treatment for localized prostate cancer. Cancer J 2007, 13:289–294.CrossRefPubMedGoogle Scholar
  21. 21.
    Roemeling S, Roobol MJ, de Vries SH, et al.: Active surveillance for prostate cancers detected in three subsequent rounds of a screening trial: characteristics, PSA doubling times, and outcome. Eur Urol 2007, 51:1244–1250.CrossRefPubMedGoogle Scholar
  22. 22.
    van den Bergh RC, Roemeling S, Roobol MJ, et al.: Outcomes of men with screen-detected prostate cancer eligible for active surveillance who were managed expectantly. Eur Urol 2009, 55:1–8.CrossRefPubMedGoogle Scholar
  23. 23.
    van den Bergh RC, Vasarainen H, van der Poel HG, et al.: Short-term outcomes of the prospective multicentre ‘Prostate Cancer Research International: Active Surveillance’ study. BJU Int 2009 Oct 8 (Epub ahead of print).Google Scholar
  24. 24.
    Shappley WV 3rd, Kenfield SA, Kasperzyk JL, et al.: Prospective study of determinants and outcomes of deferred treatment or watchful waiting among men with prostate cancer in a nationwide cohort. J Clin Oncol 2009, 27:4980–4985.CrossRefPubMedGoogle Scholar
  25. 25.
    Zhang L, Loblaw A, Klotz L: Modeling prostate specific antigen kinetics in patients on active surveillance. J Urol 2006, 176:1392–1397.CrossRefPubMedGoogle Scholar
  26. 26.
    D’Amico AV, Chen MH, Roehl KA, Catalona WJ: Preoperative PSA velocity and the risk of death from prostate cancer after radical prostatectomy. N Engl J Med 2004, 351:125–135.CrossRefPubMedGoogle Scholar
  27. 27.
    Scattoni V, Zlotta A, Montironi R, et al.: Extended and saturation prostatic biopsy in the diagnosis and characterisation of prostate cancer: a critical analysis of the literature. Eur Urol 2007, 52:1309–1322.CrossRefPubMedGoogle Scholar
  28. 28.
    Lawrentschuk N, Haider MA, Daljeet N, et al.: ‘Prostatic evasive anterior tumours’: the role of magnetic resonance imaging. BJU Int 2009 Oct 8 (Epub ahead of print).Google Scholar
  29. 29.
    Steineck G, Helgesen F, Adolfsson J, et al.; Scandinavian Prostatic Cancer Study Group Number 4: Quality of life after radical prostatectomy or watchful waiting. N Engl J Med 2002, 347:790–796.CrossRefPubMedGoogle Scholar
  30. 30.
    Burnet KL, Parker C, Dearnaley D, et al.: Does active surveillance for men with localized prostate cancer carry psychological morbidity? BJU Int 2007, 100:540–543.CrossRefPubMedGoogle Scholar
  31. 31.
    Graif T, Loeb S, Roehl KA, et al.: Under diagnosis and over diagnosis of prostate cancer. J Urol 2007, 178:88–92.CrossRefPubMedGoogle Scholar
  32. 32.
    Hou AH, Sullivan KF, Crawford ED: Targeted focal therapy for prostate cancer: a review. Curr Opin Urol 2009, 19:283–289.CrossRefPubMedGoogle Scholar
  33. 33.
    Zheng SL, Sun J, Wiklund F, et al.: Cumulative association of five genetic variants with prostate cancer. N Engl J Med 2008, 358:910–919.CrossRefPubMedGoogle Scholar
  34. 34.
    Thompson IM, Goodman PJ, Tangen CM, et al.: The influence of finasteride on the development of prostate cancer. N Engl J Med 2003, 349:215–224.CrossRefPubMedGoogle Scholar
  35. 35.
    Andriole G, Bostwick D, Brawley O, et al.: Further analyses from the REDUCE prostate cancer risk reduction trial [abstract LBA1]. Presented at the 2009 American Urological Association Annual Meeting (Late Breaking Science Forum). Chicago, Illinois; April 25–30, 2009.Google Scholar

Copyright information

© Springer Science+Business Media, LLC 2010

Authors and Affiliations

  1. 1.Division of UrologySunnybrook Health Sciences CentreTorontoCanada

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