Active surveillance for the management of localized prostate cancer: Guideline recommendations

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.

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.