Surveillance of Men with Low-Risk Prostate Cancer

Overdiagnosis and overtreatment of localized prostate cancers with low risk for progression are increasingly recognized hazards of prostate-specific antigen (PSA) screening. Two new studies are relevant to this issue.

Researchers used a U.S. observational database to estimate the prevalence of “very-low-risk” prostate cancer among men with newly diagnosed disease. Men were considered to be at very-low risk if they met all of these criteria: PSA level <10 ng/mL at diagnosis, clinical stage T1 or T2a, PSA density <0.15, fewer than 1 in 3 biopsy cores positive, and absence of Gleason patterns 4 and 5. Of nearly 2000 patients, 310 (16%) met all criteria for very-low-risk disease, but only 9% of such men chose surveillance instead of treatment.

In…