Active surveillance and watchful waiting in indolent elderly prostate cancer patients

Abstract

PSA screening, even after the age of 70, has led to the diagnosis of prostate cancers considered to be indolent. They represent a subgroup of low-risk, low-volume tumors. Active surveillance is a curative attitude based on initial surveillance and active, still curative, treatment when more aggressive tumor characteristics become evident. It is based on repeated biopsies and PSA tests. Available data are very promising, even though the available follow-up is still quite short. The 10-year specific survival is higher than 97 %. By contrast, watchful waiting is a palliative attitude where treatment is delayed until symptomatic progression occurs. This later attitude has been shown to be non inferior for overall survival compared to radical prostatectomy in non-screen-detected men above the age of 65 with a median 13 years of follow-up or screen-detected patients with a 10-year follow-up. It leads to more local symptoms, most of them being unrelated to cancer progression. It could become the standard of care for low-risk patients except for those with the longest life expectancy where active surveillance should be considered first. Both attitudes require patient's full comprehension of the issues at stake and his acceptance. It also implies regular clinical follow-up.