Although most PSA-detected cancers are slow-growing and unlikely to cause death, most men opt to undergo immediate treatment in the form of surgery or radiation.
The National Institutes of Health (NIH) convened a State-of-the-Science Conference to assess the evidence regarding observational strategies as an alternative to immediate treatment for localized prostate cancer (Ganz PA, et al. Ann Intern Med. 2012;156:591- 595). These treatments have substantial side effects, including impotence and urinary incontinence. Only a few men choose observational strategies instead of immediate treatment.
Active surveillance differs from the older observational strategy of watchful waiting, which involves relatively passive patient follow-up, in which interventions occur only when symptoms appear. By contrast, active surveillance to detect disease progression involves proactive patient follow-up, with potential repeated biopsies and eventual treatment.
To date, no randomized clinical trials have assessed the outcomes of patients who undergo active surveillance. However, early results of noncomparative cohort studies examining active surveillance in men with low-risk disease show disease-free and survival rates that are similar to those reported for immediate treatment. The panel consensus was therefore that many men could benefit from active surveillance instead of immediate treatment, recommending that active surveillance is one of the options that should be offered to patients.
In addition, the NIH panel noted that active surveillance is underused as a treatment strategy for many reasons. In some cases, when it is offered as a treatment option, it may be presented in a negative manner (ie, by referring to it as “doing nothing”). In other cases, “cancer” tends to set off an emotional response among patients that causes them to choose a more active treatment, regardless of potential side effects. Therefore, the panel suggests that physicians consider modifying the use of the word “cancer” when delivering a prostate cancer diagnosis, to allow for a discussion of active surveillance when appropriate.
