Is Active Surveillance Without Surgery Safe in Early-Stage Prostate Cancer?

At the recent 2014 European Association of Urology Congress in Sweden, active surveillance was described as safer than surgery for early-stage prostate cancer.

Although among men's most common and deadliest cancers, prostate cancer has high treatment success when detected early. Treatment varies with stage, as in other cancers. Early-stage options include surgical removal, radiotherapy and active surveillance (close monitoring) without immediate intervention. Shock and stress after diagnosis make asking all questions difficult, so physician information and guidance are essential. The ideal method remains unclear, with only some advantages and disadvantages known, making selection controversial. Patient and physician should weigh these and decide together; physicians must closely follow and assess developments.

Some earlier studies stated that, in early-stage prostate cancer, patients receiving surgery had fewer prostate cancer deaths and longer survival. However, the evidence is highly insufficient, because other studies report that this is not the case.

The congress study monitored 993 early-stage men through active surveillance for more than 20 years. Treatment was given only when needed, with no intervention unless progression signs appeared. Only 15 died from prostate cancer, and 7 developed distant spread.

This longest follow-up study showed low cancer mortality with active surveillance. Without surgical side effects and with higher quality of life, the European Association of Urology describes it as safer. The approach is thought to protect patients from unnecessary treatment and permanent effects.

In conclusion, none of these studies definitively identifies the ideal early-stage treatment, but each guides us. Physicians should follow all developments and present alternatives with all known advantages and disadvantages.