Active surveillance in Gleason 7 intermediate risk prostate cancer: is it safe?

Vol. 42 (3): 418-421 May – June, 2016

doi: 10.1590/S1677-5538.IBJU.2016.03.04


DIFFERENCE OF OPINION

Active surveillance in Gleason 7 intermediate risk prostate cancer: is it safe?
Opinion: No

Nishanth Krishnananthan 1, Nathan Lawrentschuk 1,2,3

1 University of Melbourne, Department of Surgery, Austin Health, Melbourne, Australia; 2 Department of Surgical Oncology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia; 3 Olivia Newton-John Cancer Research Institute, Melbourne, Australia


Keywords: Prostatic Neoplasms; Prostate cancer, familial [Supplementary Concept]; Watchful Waiting; Disease; Therapeutics


 

INTRODUCTION

Active surveillance (AS) is a management strategy for early-stage prostate cancer (PCa) designed to balance early detection of aggressive disease and overtreatment of indolent disease (1). It is advocated as the treatment of choice for favourable-risk disease in several national guidelines (National Comprehensive Cancer Network, National Institute for Health and Clinical Excellence) (2). Despite it’s significant role in low risk PCa, AS is not established as a standard of care for intermediate risk disease. A contemporary registry-based population study in Australia ascertained the treatment trends and patterns of care of 980 men with PCa on AS. It reported that 251 men (8.9%, Median 70.4) with intermediate risk were placed in AS, of whom 53.8% had Gleason score (GS) 3+4 PCa and 10.4% with 4+3 disease (3).

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