Active Surveillance Viable Option for Some With Prostate Cancer

"In the United States, about 40% of people who are good candidates for active surveillance are getting treated immediately. And I think that can be reduced," an expert told CURE®.

Active surveillance has been shown to be an effective management strategy for patients with favorable-risk prostate cancer, researchers found.

Active surveillance, as explained by Fred Hutchinson Cancer Center cancer prevention researcher Lisa Newcomb in an interview with CURE®, “is monitoring of favorable-risk prostate cancer and by monitoring, I mean where the patient comes back for regular PSA [prostate-specific antigen, a protein associated with the presence of prostate cancer] measurements, regular biopsies, which we feel are important, and other tests. Right now, a lot of active surveillance uses MRI, we're still working on validating its use in active surveillance. And there are a number of other tests that can be used.

“And then, importantly, if there are signs that the cancer has progressed to a more aggressive phenotype, a more aggressive cancer, then treatment is recommended, but treatment is either delayed or eliminated altogether in the majority of people.”

Favorable-risk prostate cancers, as defined by the American Cancer Society, are those that are slightly more likely to grow and spread, with the organization noting that initial treatment options can include active surveillance, surgery or radiation therapy.

Newcomb is the first author of a study published in JAMA which found that, among 2,155 patients with localized (cancer that has not spread to other parts of the body) prostate cancer, at a median follow-up of 7.2 years and 10 years after diagnosis, 49% of patients were free of progression or treatment, while less than 2% had developed metastatic (cancer that has spread to other parts of the body) disease and less than 1% had died of prostate cancer.

“Later progression and treatment during surveillance were not associated with worse outcomes,” Newcomb and her colleagues wrote. “These results demonstrate active surveillance as an effective management strategy for patients diagnosed with favorable-risk prostate cancer.”

The findings were part of the Canary Prostate Active Surveillance Study (CanaryPASS), of which Newcomb is the deputy director. Newcomb discussed the findings and the usefulness of active surveillance for some patients with prostate cancer.

CURE®: For patients, what do you hope is the big takeaway from this recent study regarding active surveillance in patients with prostate cancer?

Newcomb: I think our study clearly shows that active surveillance with regular PSA [checks] and biopsies is a very safe and effective management strategy for favorable-risk prostate cancer. Patients and clinicians can be comfortable that in these lower-stage prostate cancers treatment is not necessarily needed immediately, it can be delayed or prevented altogether.

And what are some potential benefits to patient quality of life from going the active surveillance route?

Well, treatment has a lot of side effects. Treatments [include] surgery, a prostatectomy [surgical removal of all or part of the prostate] or radiation usually, and there's incontinence, there's urinary dysfunction and treatments are expensive. So, if you can avoid those, there can be an improved quality of life.

What, if any, impact does active surveillance have on eventual treatment?

That's a good question. None. An important finding from our study was that people whose cancer progressed after many years of surveillance and then were treated did not have worse outcomes than people whose cancers progressed immediately after diagnosis and were treated.

And are there any challenges that come with active surveillance?

While there can be anxiety, I hope that our study reduces the amount of anxiety. And people do need to keep seeing the doctor, but people should see the doctor even without [having] cancer.

What sorts of conversations should patients have with their care teams regarding active surveillance?

Patients should be aware that they don't need treatment right away and should talk to their care teams about that. I think it will depend on their level of anxiety. But, in the United States, about 40% of people who are good candidates for active surveillance are getting treated immediately. And I think that can be reduced. I hope that our study helps reduce that number.

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