EAU17: Prostate Cancer Prevention Group tackles limits of active surveillance

The question of which of prostate cancer (PCa) patients are suitable for active surveillance (AS) remains a complex issue, and experts yesterday cautioned that doctors should exercise due restraint to avoid over-treatment.

The special session organized by the Prostate Cancer Prevention Group looked into the low-risk PCa and identifying patients qualified for active surveillance, such as genetic factors, dietary and lifestyle, the role of miRNA, tissue, blood and urine–based biomarkers, role of imaging, and management of low-risk disease, among others. The full-day session also presented update lectures and discussions of the three major studies on AS (ProtecT, ERSPC and PLCO).

“There is a general acceptance that there is overtreatment and that the question of screening has exacerbated that,” said Prof. Jack Cuzick (GB) who chaired the meeting with Profs. Manfred Wirth (DE) and Arnulf Stenzl (DE).

Prof. Freddie Hamdy (GB) gave updates on the ProtecT study and said the risk of death from prostate cancer over an average of 10 years is very low (1%) and that most PSA-detected clinically localized prostate cancers grow slowly.

“Surgery and radiotherapy reduce the risk of cancer progression and spread, but cause bothersome urinary, sexual and bowel symptoms,” added Hamdy. He also noted that patients who stayed on active monitoring avoid treatment side-effects. “But there is an increased risk of cancer progression and spread, and some symptoms increase gradually over time,” said Hamdy.