Active Surveillance in Men With Localized Prostate Cancer Annals of Internal Medicine, 05/02/2012
Dahabreh IJ et al. – Evidence is insufficient to assess whether Active surveillance (AS) is an appropriate option for men with localized prostate cancer. A standard definition of AS that clearly distinguishes it from watchful waiting (WW) is needed to clarify scientific discourse.
- MEDLINE and Cochrane databases (from inception to August 2011).
- Screened abstracts and reviewed full-text publications to identify eligible studies.
- One reviewer extracted data, and another verified quantitative data.
- Two independent reviewers rated study quality and strength of evidence for comparative effectiveness.
- Sixteen independent cohorts defined AS, 42 studies evaluated factors that affect the use of observational strategies, and 2 evidence reports and 22 recent studies reported comparisons of WW versus treatment with curative intent.
- The most common eligibility criteria for AS were tumor stage (all cohorts), Gleason score (12 cohorts), prostate-specific antigen (PSA) concentration (10 cohorts), and number of biopsy cores positive for cancer (8 cohorts).
- For monitoring, studies used combinations of periodic PSA testing (all cohorts), digital rectal examination (14 cohorts), and rebiopsy (14 cohorts).
- Predictors of receiving no active treatment included older age, comorbid conditions, lower Gleason score, tumor stage, PSA concentration, and favorable risk group.
- No published studies compared AS with immediate treatment with curative intent.
- Watchful waiting was generally less effective than treatment with curative intent; however, applicability to contemporary patients may be limited.