POEMs

Active Surveillance for Localized Prostate Cancer: No Increased Mortality, but Higher Rates of Clinical Progression

 

Am Fam Physician. 2017 Feb 1;95(3):196.

Clinical Question

What is the best approach to the management of localized prostate cancer?

Bottom Line

This landmark study compared active surveillance with radical prostatectomy or radiation therapy for patients with T1c or T2 prostate cancer. The benefits of active surveillance include avoiding radical therapy in one-half of the patients, with no effect on disease-specific survival or all-cause survival. The potential harms include a greater risk of metastatic disease (three additional cases per 1,000 person-years, corresponding to three additional cases for 100 men followed up for 10 years) and a greater likelihood of clinical progression. An accompanying study (N Engl J Med. 2016;375(15):1425–1437) discusses the effects on quality of life and complications of treatment. (Level of Evidence = 1b)

Synopsis

Clinically localized prostate cancer is defined as stage T1c

POEMs (patient-oriented evidence that matters) are provided by EssentialEvidence Plus, a point-of-care clinical decision support system published by Wiley-Blackwell. For more information, please see http://www.essentialevidenceplus.com. Copyright Wiley-Blackwell. Used with permission.

For definitions of levels of evidence used in POEMs, see http://www.essentialevidenceplus.com/product/ebm_loe.cfm?show=oxford.

To subscribe to a free podcast of these and other POEMs that appear in AFP, search in iTunes for “POEM of the Week” or go to http://goo.gl/3niWXb.

This series is coordinated by Sumi Sexton, MD, Associate Deputy Editor.

A collection of POEMs published in AFP is available at http://www.aafp.org/afp/poems.


 

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