Active Surveillance Once Again the Preferred Option for Low-Risk Prostate Cancer

Patients with low-risk prostate cancer may now be recommended to undergo active surveillance instead of treatments like radiation therapy or surgery, thanks to recently updated treatment guidelines from the National Comprehensive Cancer Network (NCCN).

A few months ago, patients may have been given a different direction from their doctors. In September, the NCCN published new guidelines taking away the term “preferred” preceding active surveillance, essentially giving surveillance, radiation and surgery equal weight as options for this patient population. After much debate from medical experts, the NCCN went back to its stance that most men with low-risk prostate cancer can opt for a watch-and-wait approach.

“There are a lot of data available from many different series showing superb long-term outcomes with active surveillance for men with low-risk prostate cancer, so it’s a data-based recommendation that it should be the preferred option,” said Dr. Scott E. Eggener in an interview with Urology Times®, a sister publication of CURE®.

Eggener, who is the Bruce and Beth White Family Professor of Surgery and Radiology, vice chair of urology and director of the High-Risk and Advanced Prostate Cancer Clinic at the University of Chicago, recently participated in a debate over the NCCN’s guidelines at the 2021 Society of Urologic Oncology Annual Meeting.

What to Expect on Active Surveillance

When clinicians screen for prostate cancer, they are mostly looking for higher-grade diseases, like those in Grade Group 2 or with a Gleason score of 7 or higher, Eggener explained. For those diagnosed with low-risk disease, he said that he’s not sure “whether it’s a service or disservice that they’ve been diagnosed with it.”

Eggener went on to discuss the excellent tools that are available for active surveillance, including MRI, genomic biomarkers and prostate-specific antigen (PSA) testing.

“We need to do a better job of figuring out how to integrate those and minimize the number of biopsies a man has to have, but still maintain the excellent long-term outcomes,” he said.

Avoid the Risks of Overtreatment

Patient-provider communication is key here, as many individuals may hear that they have cancer and immediately want to do treatment. Individuals who are diagnosed with low-risk prostate cancer should talk with their clinicians about their concerns and questions around active surveillance, as well as the potential risks that treatment can have.

When potential risks and side effects outweigh potential benefits, clinicians call that “overtreatment” — a long-standing problem in the United States, according to Eggener.

Active surveillance and the concept of overtreatment is not unique to prostate cancer. Experts also say that patients with small kidney tumors can avoid the potential dangers of treatment as well.

“If treatment had no side effects, or an extremely low likelihood of side effects, there would really be no controversy whatsoever,” Eggener said. “But even in expert hands, if a man undergoes surgery or radiation, there’s unfortunately a risk to their quality of life. There is some potential baggage that can come with it. The great news is that most guys do really well, but they need to understand what they’re getting involved with.”

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