INTRODUCTION - The objective is to provide guidance on the role of active surveillance (AS) as a management strategy for low-risk prostate cancer patients and to ensure that AS is offered to appropriate patients assessed by a standardized protocol. Prostate cancer is often a slowly progressive or sometimes non-progressive indolent disease diagnosed at an early stage with localized tumours that are unlikely to cause morbidity or death.
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Standard active treatments for prostate cancer include radiotherapy (RT) or radical prostatectomy (RP), but the harms from over diagnosis and overtreatment are of a significant concern. AS is increasingly being considered as a management strategy to avoid or delay the potential harms caused by unnecessary radical treatment.
METHODS - A literature search of MEDLINE, EMBASE, the Cochrane library, guideline databases and relevant meeting proceedings was performed and a systematic review of identified evidence was synthesized to make recommendations relating to the role of AS in the management of localized prostate cancer.
RESULTS - No exiting guidelines or reviews were suitable for use in the synthesis of evidence for the recommendations, but 59 reports of primary studies were identified. Due to studies being either non-comparative or heterogeneous, pooled meta-analyses were not conducted.
CONCLUSIONS - The working group concluded that for patients with low-risk (Gleason score ≤6) localized prostate cancer, AS is the preferred disease management strategy. Active treatment (RP or RT) is appropriate for patients with intermediate-risk (Gleason score 7) localized prostate cancer. For select patients with low-volume Gleason 3+4=7 localized prostate cancer, AS can be considered.
Can Urol Assoc J. 2015 May-Jun;9(5-6):171-8. doi: 10.5489/cuaj.2806.
Morash C1, Tey R2, Agbassi C2, Klotz L3, McGowan T4, Srigley J5, Evans A6.
1 Division of Urology, University of Ottawa, Ottawa, ON;
2 Program in Evidence-based Care, Cancer Care Ontario, McMaster University, Hamilton, ON;
3 Division of Urology, Sunnybrook Health Sciences Centre, Toronto, ON;
4 The Cancer Centre Bahamas & The Cancer Centre Eastern Caribbean;
5 Credit Valley Hospital, Mississauga, ON;
6 Department of Pathology and Laboratory, Faculty of Medicine, University of Toronto, Toronto, ON.