Thanks Phil…I’d be interested in a reference to the data you cite.

I am aware of a JAMA study which was published in May 2024, entitled “ Active Surveillance for Prostate Cancer: 10-Year Outcomes From the Canary Prostate Active Surveillance Study” (study summary link below).

This study consisted of 2300 men who were followed on AS over a 10 year period, results follows:

• Discontinuation Rate: After 10 years, 49% of men remained on AS without treatment or progression, meaning 51% discontinued AS for various reasons.

• Primary Reasons for Discontinuation:

1. Disease Progression: Approximately 43% of men transitioned to treatment due to signs of progression, such as Gleason score upgrades (e.g., from 6 to 7 or higher), increased tumor volume on biopsy, or PSA doubling time indicating risk reclassification. This aligns with clinical triggers for intervention.

2. Patient Choice: Around 8% of men opted for treatment without evidence of progression, often driven by anxiety, preference for definitive action, or external influences (e.g., family pressure). This reflects the psychological burden of living with untreated cancer.

3. Other Factors: Less than 2% developed metastatic disease, and less than 1% died of prostate cancer, suggesting that some discontinuations were precautionary rather than strictly necessary. A small fraction also dropped out due to logistical issues (e.g., follow-up burden) or switched to watchful waiting as they aged.

• Validation of AS: Men who switched to treatment after years of AS had outcomes (e.g., metastasis rates, adverse pathology) comparable to those treated immediately, reinforcing that delays due to AS don’t worsen prognosis for most.

So this 2024 study found 43% of men on AS sought treatment after seeing some clinical evidence of progression, 8% sought treatment for other than clinical evidence reasons and 49% were still on AS after 10 years…..but less than 2% developed metastatic disease and less than 1% died of PCa.

So, statistically speaking, folks choosing AS are “flipping a coin”…heads you won’t need treatment after ten years and tails you will….but dying of PCa in 10 years is less than a 1/100 chance….now I like those odds😉

All the best,
Alan
https://www.fredhutch.org/en/news/releases/2024/05/active-surveillance-shown-to-be-an-effective-management-strategy.html