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Current Status of Clinical Trials in Active Surveillance

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The Prostate Cancer Dilemma

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Abstract

Active surveillance is an effective solution to the widely recognized problem of overtreatment of screen-detected prostate cancer. The benefits of avoiding overtreatment are readily apparent. Prospective phase 2 studies including more than 5000 patients have reported a low rate of prostate cancer metastasis and death. A randomized phase 3 trial comparing surveillance to radical intervention was launched in 2007, it failed to accrue adequately and closed unsuccessfully. One large-scale trial (PROTECT) randomizing patients from all-risk groups between surgery, radiation, and surveillance is expected to report results in 2016. Adoption of an active surveillance program for low-risk disease could reduce overall mortality without an increase in prostate cancer deaths and provide substantial cost savings (estimated at up to $1.32 billion/year in the US). The approach to surveillance continues to evolve, and the incorporation of improved imaging and molecular biomarkers is certain to improve individual risk characterization, and therefore long-term outcome. The role of mpMRI in men on surveillance is currently the subject of intensive investigation, and should be clarified within the next few years. Currently it is indicated for men with a grade or volume increase, or adverse PSA kinetics. Treatment should be offered for most patients with upgraded disease.

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  1. Sunnybrook Health Sciences Centre, 2075 Bayview Ave., MG408, Toronto, ON, Canada, M4N 3M5

    Laurence Klotz M.D.

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  1. Laurence Klotz M.D.
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Correspondence to Laurence Klotz M.D. .

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  1. Department of Urology, The Icahn School of Medicine at Mount Sinai, Professor of Urology and Radiation Oncology, New York, New York, USA

    Nelson N. Stone

  2. Radiation Oncology, University of Colorado, Denver , Professor of Urology/Surgery, Aurora, Colorado, USA

    E. David Crawford

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Klotz, L. (2016). Current Status of Clinical Trials in Active Surveillance. In: Stone, N., Crawford, E. (eds) The Prostate Cancer Dilemma. Springer, Cham. https://doi.org/10.1007/978-3-319-21485-6_10

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  • DOI: https://doi.org/10.1007/978-3-319-21485-6_10

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