Active Surveillance a Reasonable Alternative in Localized Prostate Cancer

Active surveillance = serial PSAs, DREs and prostate biopsies
n = 1298 men over 20 years, Johns Hopkins study
Inclusion:  very-low-risk (T1c, PSA density < 0.15, Gleason < 6, 2 or fewer positive bx cores, < 50% of core involved) or low-risk (<T2a, PSA <10, Gleason <6).
All pts underwent semi-annual PSA, DRE, annual bx.
Intervention when surveillance revealed worsening disease.
Median f/u 5 years.
At end of study, 50% were under active surveillance, 36% had interventions, and 14% undecided re: intervention, lost to f/u or dead.
Of 49 deceased pts, 47 died from something other than prostate CA.
Rate of overall survival = 93%
Rate of cancer-specific survival = 99.9%
Rate of met-free survival = 99.4%
at 10 years.
Conclusion:  Study limited by ethnic homogeneity and short f/u time.  Still, men with low-risk localized prostate CA should be encouraged to consider active surveillance rather than curative intervention.
J Clin Oncol 2015 Oct 20; 33:3379

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