The management of clinically localised prostate cancer diagnosed after a PSA test remains controversial.
Active surveillance is an option that can help ameliorate the negative effects of over-treatment of PSA-detected prostate cancer. The longer term outcomes of this approach compared to active treatment after diagnosis (surgery and/or radiotherapy) are still uncertain, with concerns about worse outcomes for men undergoing active surveillance.
A recent study reporting 10-year survival outcomes of men in the ProtecT trial, published in the New England Journal of Medicine, showed a very low prostate-cancer-specific mortality at 10 years (1%) irrespective of whether the man was assigned to active surveillance, surgery or radiotherapy.
Given the relatively small number of deaths, longer term data are needed to fully assess the relative merits of each treatment option, along with data on side-effects of treatments and the impacts of treatment on quality of life.