Active Surveillance in Men With Localized Prostate Cancer
Annals of Internal Medicine, 05/04/2012Dahabreh 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.
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