Active surveillance for early-stage prostate cancer

Review of the current literature

Authors

  • Marc A. Dall'Era MD,

    Corresponding author
    1. Department of Urology, University of California at San Francisco Comprehensive Cancer Center, University of California at San Francisco, San Francisco, California
    • Department of Urology, University of California at San Francisco Comprehensive Cancer Center, University of California at San Francisco, 1600 Divisadero, Box 1695, San Francisco CA 94143-1695
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    • Fax: (415) 353-7093

  • Matthew R. Cooperberg MD,

    1. Department of Urology, University of California at San Francisco Comprehensive Cancer Center, University of California at San Francisco, San Francisco, California
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  • June M. Chan ScD,

    1. Department of Urology, University of California at San Francisco Comprehensive Cancer Center, University of California at San Francisco, San Francisco, California
    2. Department of Epidemiology and Biostatistics, University of California at San Francisco, San Francisco, California
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  • Benjamin J. Davies MD,

    1. Department of Urology, University of California at San Francisco Comprehensive Cancer Center, University of California at San Francisco, San Francisco, California
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  • Peter C. Albertsen MD,

    1. Division of Urology, University of Connecticut Health Center, Farmington, Connecticut
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  • Laurence H. Klotz MD,

    1. Division of Urology, Sunnybrook and Women's College Health Sciences Centre, University of Toronto,Toronto, Ontario, Canada
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  • Christopher A. Warlick MD,

    1. Department of Urology, Johns Hopkins University School of Medicine, James Buchanan Brady Urological Institute, Baltimore, Maryland
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  • Lars Holmberg MD,

    1. Division of Cancer Studies, Kings College London, Guys Campus, London, United Kingdom
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  • Donald E. Bailey Jr PhD, MN,

    1. School of Nursing, Duke University, Durham, North Carolina
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  • Meredith E. Wallace PhD, APRN-BC,

    1. School of Nursing, Fairfield University, Fairfield, Connecticut
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  • Philip W. Kantoff MD,

    1. Center for Genitourinary Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts
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    • Dr. Kantoff has acted as a paid consultant/advisor for Dendreon, Celgene, Aventis, GPC, Amgen, and Novacea. He has also acted as an investigator for clinical trials for Novartis, Pfizer, Amgen, Bayer, Glaxo Smith Kline, Therion Biologics, Bristol Myers-Squibb, Wilex, Genentech, and Genzyme.

    • The last 2 authors are co-senior authors.

  • Peter R. Carroll MD

    1. Department of Urology, University of California at San Francisco Comprehensive Cancer Center, University of California at San Francisco, San Francisco, California
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    • The last 2 authors are co-senior authors.


Abstract

The natural history of prostate cancer is remarkably heterogeneous and, at this time, not completely understood. The widespread adoption and application of prostate-specific antigen (PSA) screening has led to a dramatic shift toward the diagnosis of low-volume, nonpalpable, early-stage tumors. Autopsy and early observational studies have shown that approximately 1 in 3 men aged >50 years has histologic evidence of prostate cancer, with a significant portion of tumors being small and possibly clinically insignificant. Utilizing the power of improved contemporary risk stratification schema to better identify patients with a low risk of cancer progression, several centers are gaining considerable experience with active surveillance and delayed, selective, and curative therapy. A literature review was performed to evaluate the rationale behind active surveillance for prostate cancer and to describe the early experiences from surveillance protocols. It appears that a limited number of men on active surveillance have required treatment, with the majority of such men having good outcomes after delayed selective intervention for progressive disease. The best candidates for active surveillance are being defined, as are predictors of active treatment. The psychosocial ramifications of surveillance for prostate cancer can be profound and future needs and unmet goals will be discussed. Cancer 2008. © 2008 American Cancer Society.

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