Active Surveillance in Men With Localized Prostate Cancer

Annals of Internal Medicine, 05/02/2012

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.

Methods

  • 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).

Results

  • 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.

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