| Active surveillance may be a reasonable option in carefully selected men with low-risk prostate cancer Active surveillance is a reasonable option for carefully selected men under 60 with low-risk prostate cancer say researchers at the 112th Annual Scientific Meeting of the American Urological Association (AUA). However, patients must be surveyed closely and understand the significant risk of ultimately needing treatment. The Active Surveillance for Low-Risk Prostate Cancer in Men Under 60 Years of Age study reports that in men with low-risk prostate cancer, the use of active surveillance is increasing; however, outcomes data relative to the use of active surveillance in men under 60 years of age is limited. Using active surveillance data from Massachusetts General Hospital in Boston and Sunnybrook Health Sciences Centre in Toronto, researchers analyzed clinical outcomes for 432 men on active surveillance protocols. At diagnosis, the patients' median age was 55 years (IQR 53-57) and median PSA was 4.6 ng/mL (IQR 3.1-5.9), with only 11 of 432 men with PSA ≥10 ng/mL. The vast majority of patients had Gleason ≤6 (97.7%) and clinical stage T1 (91.9%) disease. Of this group, 131 patients (30.3%) were ultimately treated (the majority due to pathological progression (64.1%), PSA progression (18.3%), volume progression (3.1%) or patient preference (11.5%). Among the 131 treated patients, 62.6% underwent radical prostatectomy, 13.0% underwent high-intensity focal ultrasound therapy, 12.2% underwent external beam radiation and 10.7% had brachytherapy. Five patients developed metastasis (2 with positive lymph nodes at time of radical prostatectomy, 3 with distant metastasis). Metastasis-free survival was 99.7 percent at five years and 97.5 at 10 years. There were no prostate-cancer specific deaths. The Boston and Toronto based researchers conclude that active surveillance may be a reasonable option in carefully selected younger men. |