Identification of candidates for observation - Abstract

PURPOSE OF REVIEW: The clinical value of active surveillance may still be limited due to acceptance and considerable misclassification rates, and inadequate follow-up criteria.

This review focuses on the most recent developments in the use of active surveillance and patient-specific factors that may be used to identify patients suitable for this strategy.

RECENT FINDINGS: The number of patients diagnosed with low-risk prostate cancer has risen. Active surveillance acceptance rates are increasing, but still limited and varying importantly (2-49%). Misclassification is inevitable in all currently used protocols, although most of these patients still have relatively favorable-risk prostate cancer. African-American race, obese, and older-aged patients show more unfavorable intermediate results in an active surveillance situation. These are unlikely to be explained by the small differences in preoperative characteristics only. Psychological profiling may also be added to the selection process. Most studies report intermediate endpoints only.

SUMMARY: Patient-specific factors may be incorporated when identifying patients for active surveillance. This does not imply that active surveillance is not justified in specific groups, but may suggest the need for an intensified and personalized selection, instead of a one-size-fits-all approach.

Written by:
van den Bergh RC, Murphy DG, Costello AJ.   Are you the author?
Utrecht University Medical Centre, Utrecht, The Netherlands; Peter MacCallum Cancer Centre; Royal Melbourne Hospital, Melbourne, Australia.

Reference: Curr Opin Urol. 2015 Feb 17. Epub ahead of print.

PubMed Abstract
PMID: 25692721 Prostate Cancer Section