MedWire News: Active surveillance is an effective management strategy for men with low-risk prostate cancer, research suggests.

Active surveillance is increasingly being used in men whose prostate cancer is confined to the prostate and who are at low risk for disease progression. To help ensure that they remain healthy, they commonly undergo testing and repeat biopsies at regular intervals.

In one study, presented at the American Urology Association's annual meeting in Orlando, Florida, USA, Dr Scott Eggener, from Memorial Sloan-Kettering Cancer Center in New York, USA, and team reviewed data from 262 men with localized prostate cancer undergoing active surveillance after at least two biopsies. Patients were monitored for approximately 30 months.

The results showed that the presence of cancer in a second biopsy, as well as the number of positive samples (or cores) during the first plus second biopsies, strongly predicted disease progression. Overall, patients had a 95%, 91% and 75% probability of remaining on active surveillance at 1, 2 and 5 years, respectively.

Nevertheless, findings of a second study, conducted by Dr Ryan Miyamoto, from the University of Texas Health Sciences Center in San Antonio, USA, and colleagues suggest that standard tests are unreliable for predicting disease progression among these men.

For example, 42% of patients with previously abnormal digital rectal findings had subsequent normal results, while 22% with normal results had subsequent abnormal results. Likewise, a positive prostate-specific antigen, indicative of prostate cancer risk, at initial biopsy insufficiently predicted later biopsy findings in as many as 67% of patients.

Researchers conclude that while active surveillance is an acceptable and feasible alternative to curative treatment in men with low-risk, localized prostate cancer, better diagnostic tests are needed to ensure that disease is confined.