Recent reviews, reports and research relating to active surveillance and watchful waiting

Time for active surveillance of intermediate-risk disease? Author: Hashim U. Ahmed. Nat. Rev. Urol. 10, 6–8 (2013); published online 13 November 2012; doi:10.1038/nrurol.2012.213 Author's abstract: Active surveillance has become increasingly popular as a management option for localized prostate cancer. Although widely viewed as a means to enable men with low-risk prostate cancer to avoid or defer the effects of whole-gland radical therapy, two new studies demonstrate that it might be a safe approach in intermediate-risk disease.

Prostate Cancer Intervention Versus Observation Trial (PIVOT) results. This study was conducted by Timothy J Wilt et al and an abstract of the study is reported here: http://tinyurl.com/cshj8ol In the period 1994 to 2004, 731 men with localised prostate cancer were assigned randomly to two groups: radical prostatectomy and observation. Prostate-cancer-specific and all-causes deaths amongst the two groups was assessed in 2010. This article by Dr. Allan S Brett provides an informative analysis of the results: http://www.medscape.com/viewarticle/768851 Brett notes that: "At median follow-up of 10 years, neither all-cause mortality nor prostate cancer–specific mortality was significantly lower in the prostatectomy group than in the observation group. However, among men with PSA levels of more than 10 ng/mL, mortality was lower with prostatectomy (see Table). Subgroups with higher-risk cancers (defined by criteria incorporating PSA levels, Gleason scores, and tumor staging) also showed trends toward lower mortality with surgery. Bone metastases occurred in 4.7% of prostatectomy patients and in 10.6% of observation patients..." A copy of that article including the very illuminating table can also be downloaded as a 98 KB PDF file from our web site here.