Elsevier

The Lancet Oncology

Volume 5, Issue 2, February 2004, Pages 101-106
The Lancet Oncology

Review
Active surveillance: towards a new paradigm in the management of early prostate cancer

https://doi.org/10.1016/S1470-2045(04)01384-1Get rights and content

Summary

Prostate cancer is the only human cancer that is curable but which commonly does not need to be cured. Active surveillance is a new strategy that aims to individualise therapy by selecting only those men with significant cancers for curative therapy. Patients with favourable tumour characteristics are closely monitored using serum prostate specific antigen (PSA) concentrations and repeat prostate biopsies. The choice between radical treatment and continued observation is based on evidence of disease progression, defined in terms of the PSA doubling time, and “upgrading” at repeat biopsy. Active surveillance provides an excellent opportunity for studies to identify markers of prostate-cancer behaviour. Knowledge of prostate cancer biomarkers would have an immediate effect on clinical decision-making and would also identify targets for the development of novel therapeutic strategies. In the longer term, active surveillance may accelerate progress towards a new treatment paradigm for early prostate cancer based on the selective use of therapies designed, not to eradicate the disease, but to alter its natural history.

Section snippets

Some men benefit from radical treatment

Prostate cancer, unlike cancers of other sites, often has a very indolent natural history. Whereas patients with any other curable cancer would automatically be offered radical treatment, “watchful waiting” has been a recognised approach to managing prostate cancer, with acceptable results in selected patients.3 In fact, the first good evidence that some men benefit from radical treatment of localised prostate cancer has only recently become available. From 1989 to 1999, the Scandinavian

Search strategy and selection criteria

Published data for this article were identified by a MEDLINE search with combinations of the search terms: “prostatic neoplasms”, “watchful waiting”, and “conservative management”. References from relevant articles, and the author's personal collection were also included. Only articles published in English in the PSA era (since 1990) were considered. Papers were selected if they included clinical outcome data from patients with localised prostate cancer managed conservatively, but with

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