Active surveillance for early-stage prostate cancer: review of the current literature.
The natural history of prostate cancer is remarkably heterogeneous and, at this time, not completely understood. The widespread adoption and application of prostate-specific antigen (PSA) screening has led to a dramatic shift toward the diagnosis of low-volume, nonpalpable, early-stage tumors. Autopsy and early observational studies have shown that approximately 1 in 3 men aged >50 years has histologic evidence of prostate cancer, with a significant portion of tumors being small and possibly clinically insignificant. Utilizing the power of improved contemporary risk stratification schema to better identify patients with a low risk of cancer progression, several centers are gaining considerable experience with active surveillance and delayed, selective, and curative therapy. A literature review was performed to evaluate the rationale behind active surveillance for prostate cancer and to describe the early experiences from surveillance protocols. It appears that a limited number of men on active surveillance have required treatment, with the majority of such men having good outcomes after delayed selective intervention for progressive disease. The best candidates for active surveillance are being defined, as are predictors of active treatment. The psychosocial ramifications of surveillance for prostate cancer can be profound and future needs and unmet goals will be discussed.
Dall'Era
Marc A
MA
Department of Urology, University of California at San Francisco Comprehensive Cancer Center, University of California at San Francisco, San Francisco, California 94143-1695, USA. mdallera@urology.ucsf.edu
Cooperberg
Matthew R
MR
Chan
June M
JM
Davies
Benjamin J
BJ
Albertsen
Peter C
PC
Klotz
Laurence H
LH
Warlick
Christopher A
CA
Holmberg
Lars
L
Bailey
Donald E
DE
Wallace
Meredith E
ME
Kantoff
Philip W
PW
Carroll
Peter R
PR
D018450:Disease Progression; D005544:Forecasting; D006801:Humans; D008297:Male; D008403:Mass Screening; D017063:Outcome Assessment, Health Care; D011159:Population Surveillance; D017430:Prostate-Specific Antigen / Q000032:analysis; D011471:Prostatic Neoplasms / Q000175:diagnosis*; D018570:Risk Assessment; D014481:United States
D017430:Prostate-Specific Antigen