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while others abandon it, choosing to either undergo
definitive treatment or simply manage their disease with
watchful waiting.
In this issue of
European Urology
, Van Hemelrijck et al
[8]present results for a Markov model that explores the
outcomes for patients who elected to undergo active
surveillance in Sweden during the past 25 yr. They used
data from multiple registries to assemble a cohort of men
with low-risk prostate cancer and to calculate the
probabilities that these men stayed on active surveillance
or transitioned to another strategy. Their analysis provides
dramatic insights and their figure offers patients visual cues
concerning their likely trajectory.
Their results confirm that approximately 25% of men of
all ages will abandon active surveillance after 2–3 yr of
follow-up. After that there is constant erosion, so that by
10 yr only 25% of men remain on active surveillance.
Younger men are more likely to transition to some type of
definitive treatment, while men older than 70 yr are likely
to abandon active surveillance in favor of watchful waiting.
The recent publication of the PROTECT trial results confirms
these findings
[9] .Approximately 25% of the men in the
active monitoring arm had abandoned active surveillance
by 3 yr, and 55% had received a radical intervention by 10 yr.
None had transitioned to watchful waiting, since this was
not part of the trial design.
Active surveillance is an appropriate treatment for
many men with low-volume, low-grade prostate cancer.
However, men embarking on this treatment strategy should
recognize that most will transition to an alternative strategy
within a decade. Van Hemelrijck et al have provided men
with an easily understood figure to grasp these concepts.
Clinicians and researchers should seize this insight by
developing active surveillance protocols that extend over
10 yr.
Conflicts of interest:
The author has nothing to disclose.
References
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Schroder FH, Hugosson J, Roobol MJ, et al. Prostate-cancer mortality at 11 years of follow-up. N Engl J Med 2012;366:981–90.[4]
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