Historically, too many men were haphazardly treated for prostate cancer. Happily, the incidents of over treatment have been declining and the general acceptance of Active Surveillance has emerged as the preferred management strategy for men with very low–risk prostate cancer. However, There is still too few high-quality comparative effectiveness studies evaluating the incremental risks associated with or active surveillance.
In a prospective study published in the Journal of Urology, researchers reported the risk men face of developing metastatic disease. They evaluated a large, mature, active surveillance cohort.
It was reported that, at median follow-up of 6 years, 3.1% of men in the surveillance cohort developed metastatic prostate cancer. They found that three situations were all associated with increasing risk of a man developing metastatic disease:
1- The presence of Gleason 7 disease
2- PSA doubling time less than 3 years
3- The presence of three or more positive cores on initial biopsy
The decision to pursue active treatment for prostate cancer is not clean cut. It needs to have, as a major decision component, a risk based benefit analysis. These data can help us better understand the incremental risks associated with surveillance as we move a head with our decision-making.