Active surveillance for good risk prostate cancer: rationale, method, and results.

BACKGROUND

Many newly diagnosed patients with prostate cancer have "good risk" disease. The challenge is to identify the minority of these patients with aggressive disease and offer them curative treatment, while sparing the remainder the morbidity of unnecessary treatment.

PURPOSE

To examine the results of active surveillance with selective delayed intervention in good risk prostate cancer patients.

MATERIALS AND METHODS

This was a prospective phase II study of active surveillance of 299 patients. Eighty percent (239 patients) met the criteria for good risk disease: PSA < 10 ng/mL, Gleason < 6, T < 2a. Twenty percent of patients, all of whom who were age 70 or greater, had Gleason 7 cancer or a PSA above 10.

RESULTS

At 8 years, overall survival is 85% and disease-specific survival is 99%. A PSA doubling time of < 2 years was linked with likelihood of locally advanced disease.

CONCLUSION

Watchful waiting is clearly appropriate for elderly prostate cancer patients with high co-morbidities. For good risk, young, healthy patients, this study supports the feasibility of long-term, close monitoring with early intervention for those who progress rapidly. Approximately two thirds of such patients will remain free of treatment over 8 years.