Prostate cancer-specific survival at 10 years is slightly lower among men with low-grade disease undergoing active surveillance compared with active treatment, according to population-based data published in The Journal of Urology.

“Although outcomes on [active surveillance] are excellent, these results do suggest that some men are misclassified or may miss an opportunity for cure,” Antonio Finelli, MD, of the University of Toronto, Princess Margaret Cancer Centre, in Canada, and colleagues wrote.

In the retrospective study, Dr Finelli and colleagues compared long-term cancer outcomes among 21,282 men receiving active surveillance or definitive treatment with radiation or surgery in Ontario, Canada, from 2002 to 2014.

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At 10 years, 39% of men remained on active surveillance. The 10-year prostate cancer-specific survival rates were 98.1% in the active surveillance group and 99.1% in the initial treatment group. The 10-year metastasis-free survival rates were 94.2% and 95.8%, respectively, and the 10-year overall survival rates were 88.7% and 89.9%, respectively.

In a landmark analysis, active surveillance was significantly associated with a 34% increased risk of metastasis, a 12% increased risk of all-cause mortality, and a 66% increased risk of prostate cancer-specific mortality compared with initial treatment. In a propensity-score matched analysis, active surveillance was significantly associated with a 28%, 12%, and 87% increased risks of these outcomes, respectively, compared with initial treatment.

The investigators calculated that 125 men on active surveillance would need to receive initial treatment to prevent 1 prostate cancer death at 10 years. The team cautioned that overtreatment is associated with potential urinary, bowel, and sexual-related harms.

The findings highlight “a need for a careful discussion between patient and clinician to balance treatment-related side effects and impact on quality of life vs the modest decrease in PC [prostate cancer]-specific mortality associated with intervention,” Dr Finelli’s team wrote.


Timilshina N, Alibhai SMH, Tomlinson G, et al. Long-term outcomes following active surveillance of low-grade prostate cancer: A population-based study using a landmark approach. J Urol. doi:10.1097/JU.0000000000003097

This article originally appeared on Renal and Urology News