WASHINGTON, D.C.—Active surveillance for screen-detected localized prostate cancer (PCa) does not increase the risk of death from prostate cancer (PCa) relative to definitive local treatment, a study found.
In addition, appropriately selected patients managed with active surveillance experience improved overall survival compared with patients treated with external beam radiotherapy (EBRT) or brachytherapy.
The findings emerged from a study of 12,458 men with clinical localized PCa. Of these, 7,672 underwent RP, 2,467 had EBRT, 2,319 had brachytherapy, and 452 were managed with active surveillance. Both EBRT and brachytherapy were associated with a twofold increased risk of death from any cause compared with active surveillance.
Among men with low-risk disease, those treated with EBRT or brachytherapy had a 2.7 times increased risk of death from any cause compared with active surveillance. None of the treatments, however, were associated with a significantly reduced risk of death from prostate cancer, either in the entire cohort or among low-risk patients, investigator Kiranpreet Khurana, MD, a urology resident at Cleveland Clinic in Ohio, reported at the American Urological Association 2011 annual meeting.
The main thrust of the study findings, Dr. Khurana said is that “we should have an open mind about active surveillance.”
As to why EBRT and brachytherapy were associated with greater overall mortality compared with active surveillance, Dr. Khurana noted that only a randomized, controlled trial can zero in on the reasons. “There could have been some confounding variables that we may not have adjusted for,” she said.