Study finds active surveillance best for older men with low- risk prostate cancer

A recent Swedish study of more than 23,000 men found active surveillance if the most appropriate treatment for older men with low-risk prostate cancer. However, for younger men diagnosed with intermediate-risk prostate cancer, the benefits from active surveillance are not as good and require more medical intervention to fight the disease successfully.

What is active surveillance?

Active surveillance is a good option for men with low-risk prostate cancer or whose disease is very slow growing, confined to the prostate, and unlikely to spread or metastasize. Men deemed good candidates for active surveillance still have regular follow-up exams, These exams include a digital rectal exam (DRE) and a prostate-specific antigen (PSA) blood test every three to six months, and a prostate biopsy every one to two years. 

The more relaxed active surveillance approach may be appropriate as long as men comply with regular checkups and testing and can manage the stress of living with cancer in their prostate. Active surveillance means men are still active participants in having their prostate cancer screened. If, at any time, the cancer changes, men will have to decide whether to consider surgery or radiation with their doctor’s advice. 

Study findings

One of the concerning findings from the study was that men diagnosed with prostate cancer at age 55 or younger and on active surveillance had the highest death rates. In addition these men 55 and younger who died of the disease before age 85 while on active surveillance, had a death rate of 9%, 13%, and 15% respectively, when compared to older men with very-low, low-, or intermediate risk disease, also on active surveillance.  

Researchers with the study also reviewed estimating a man’s remaining treatment-free life-years by age and their risk category for prostate cancer.  The finding showed that the mean proportion of men with remaining life-years on active surveillance and diagnosed at age 55 was 48%, 36%, and 29% for very low, low-, and intermediate-risk prostate cancer, respectively. However, men aged 70 at the time of diagnosis had a higher proportion of remaining life-years when on active surveillance of 77%, 66%, and 60% with very low, low-, and intermediate-risk prostate cancer, respectively. 

In conclusion

The conclusion found by this study was that men older than 65 years with low-risk prostate cancer have a better proportion of treatment-free years (active surveillance) and a lower risk of dying from the disease than men 65 or younger. 

The takeaway for doctors treating men with very-low to low-risk prostate cancer is that depending on a man’s age, the optimal treatment for prostate cancer management appears to be active surveillance for men 65 and older and more aggressive treatment options (surgery or radiation) for younger men. 

While there are many factors to consider, older men with very low to low-risk prostate cancer can feel confident using the more relaxed active surveillance approach if their doctor agrees with this decision. 

Dr. David Samadi is the Director of Men’s Health and Urologic Oncology at St. Francis Hospital in Long Island. He’s a renowned and highly successful board certified Urologic Oncologist Expert and Robotic Surgeon in New York City, regarded as one of the leading prostate surgeons in the U.S., with a vast expertise in prostate cancer treatment and Robotic-Assisted Laparoscopic Prostatectomy.  Dr. Samadi is a medical contributor to NewsMax TV and is also the author of The Ultimate MANual, Dr. Samadi’s Guide to Men’s Health and Wellness, available online both on Amazon and Barnes & Noble. Visit Dr. Samadi’s websites at robotic oncology and prostate cancer 911.