Active surveillance may be a suitable option for many men with low-risk prostate cancer (PCa), Swedish researchers concluded.
Pär Stattin, MD, PhD, of Umeå University Hospital in Umeå, and colleagues identified 6,849 patients in the National Prostate Cancer Registry of Sweden. Subjects were aged 70 years or younger with local clinical stage T1-2 disease, a Gleason score of 7 or less, and a serum PSA level below 20 ng/mL. Of these patients, 2,021 were managed with active surveillance and 4,828 underwent treatment with curative intent (3,399 with radical prostatectomy and 1,429 with radiotherapy). Patients had a median follow-up of 8.2 years.
The calculated cumulative PCa-specific mortality after 10 years of follow-up was 3.6% in the surveillance group and 2.7% in the treatment groups. Among the 2,686 men with low-risk disease, PCa-specific mortality was 2.4% in the surveillance group and 0.7% in the treatment groups, according to a report in the Journal of the National Cancer Institute (2010;102:950-958).
All-cause mortality in the full cohort was lower than expected, “indicating that, in clinical practice, there is a selection of healthy men for PSA testing and further work-up, leading to a diagnosis of localized prostate cancer,” the researchers noted.
The surveillance group had a higher proportion of deaths from competing causes than the surgery and radiation groups (17.6% vs. 6.8% and 10.9%).