Active surveillance vs. RP: Modest difference in mortality

The difference in prostate cancer mortality among men with low-risk disease who choose active surveillance versus those who choose immediate treatment with radical prostatectomy is likely to be very modest-possibly as little as 2 to 3 months-a new research model has estimated.

The model, developed by Ruth Etzioni, PhD, and colleagues at Fred Hutchinson Cancer Research Center in Seattle, is among the first to use specific data from published studies to project the likelihood of prostate cancer mortality among men with low-risk disease who choose active surveillance. Results were published online in Clinical Cancer Research (Sept. 24, 2012).

In the study, Dr. Etzioni and colleagues developed a simulation model to estimate prostate cancer mortality in men who would undergo active surveillance and compared that with the mortality of men treated with immediate radical prostatectomy. Using data from separate patient groups, they populated their model with time from diagnosis to treatment for men undergoing active surveillance, time from surgery to recurrence for men undergoing radical prostatectomy, and time from recurrence after prostatectomy to death.

The model projected that 2.8% of men who undergo active surveillance would die from their disease within 20 years of their diagnosis compared with 1.6% of men who undergo immediate prostatectomy. The reduced risk for prostate cancer mortality by undergoing immediate prostatectomy amounted to an average of 1.8 months of additional life per patient. In comparison, those men who chose active surveillance would have an average of 6.4 years of life free from treatment and its side effects.

"Although this is not a new result, it is confirmation of what we expected and it substantiates data from previous studies looking at watchful waiting," Dr. Etzioni said. "Very few men with low-risk disease die from prostate cancer regardless, and the difference between treatments appears to be very modest."

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