Active Surveillance might be a good option for younger men with Prostate Cancer


Active surveillance (AS) has become a popular option for patients with low risk prostate cancer. A recent meta-analysis conclude that the risk of progression is related with the patient age. The younger the patient is and the less the risk of disease progression.

In a meta-analysis of 8 studies including 6522 patients with a median age of 65.8 years (range 41 to 86 years), it has been found that each decade decrease in age was associated with an average 13% to 17% lower risk of Gleason score (GS) upgrading and 12% to 20% lower risk of pathologic biopsy progression, respectively.

Thus, a patient aged 50 years would be expected to have an average 13% to 17% lower risk of GS upgrading and 12% to 20% lower risk of biopsy progression compared with a patient aged 60 years. Compared with a patient aged 70 years, the 50-year-old man would be expected to have an average of 26% to 34% lower risk of GS upgrading and an average 24% to 40% lower risk of biopsy progression.

Many urologists are skeptical to place younger patients on AS; however, younger patients may in fact have the most to benefit from AS.

Younger patients are more likely to have a lower incidence of erectile and/or voiding dysfunction at the time of PCa diagnosis. Immediate treatment may impose an increased risk of side effects such as incontinence and impotence. The investigators cited previous studies suggesting that the implications of active treatment also may result in treatment regret in addition to a lower quality of life.

Contrary to many urologists' practice, younger patients may be good candidates for AS if the strict criteria of AS were uniformly enforced.

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