Expanding active surveillance for low-risk prostate cancer
Actively looking for disease progression is key.
Daniel Lin, MD
“All the clinical guidelines recommend active surveillance for men with low-risk prostate cancer,” said Daniel Lin, MD, professor and interim chair of urology, Pritt Family Endowed Chair in prostate cancer research and director of the Institute of Prostate Cancer Research at the University of Washington. “When we have looked at how these men have done over time, we’re talking 10, 15, 20 years, men with low-risk prostate cancer did uniformly well on active surveillance. It is not only safe, but is the preferred option.”
Dr. Lin will explore the latest data on active surveillance during his State-of-the-Art Lecture “Active Surveillance for Low-Risk Prostate Cancer: What Clinical Trials Teach Us” during this morning’s Plenary, 9-9:15 a.m. in the Venetian Ballroom. The key message,
Dr. Lin said, is men with low-risk disease should be on active surveillance with the emphasis on “active.”
Active surveillance is not watching with just regular PSA testing and periodic MRIs while waiting for progression, he explained. Men with stable PSAs and negative MRIs need repeat prostate biopsies to track potential disease progression.
Certain findings, especially high PSA density and high volume of disease on initial biopsy, suggest a higher likelihood that more aggressive disease will be found during active surveillance.
Clinical trials have demonstrated that repeat MRI cannot replace repeat biopsy for men who have biopsy-confirmed prostate cancer. There is some indication that men who do not undergo routine repeat biopsy may do worse than those who have routine repeat biopsies.
Trials have found that about half of men on active surveillance progress around the 10-year point and require treatment. It takes an active element, repeat biopsy, to identify progression early enough to treat it successfully.
“If you’re not actively looking for worse disease, you’re not going to find it and treat it early enough,” Dr. Lin said. “And if you don’t treat prostate cancer early enough, you are likely to have worse outcomes.”
At this time, the current generation of biomarkers have not been proven to be definitively helpful for men with low-risk prostate cancer specifically on active surveillance, he continued. Multiple trials with various biomarkers have shown utility for more advanced disease, but biomarkers do not appear to provide clear benefit in assessing progression or risk of progression in typical low-risk disease on active surveillance.
“I want to change practice with this lecture and expand the appropriate use of active surveillance,” Dr. Lin said. “Active surveillance is not just PSAs and MRIs, it is actively looking for disease progression. We know better, and we can do better.”
