Platinum Priority – EditorialReferring to the article published on pp. 261–280 of this issueTime for a “Radical” Change to Active Surveillance for Prostate Cancer?
Section snippets
The development of AS
The history of AS is relatively short and somewhat controversial. The concept was first discussed as a strategy distinct from watchful waiting in the late 1990s and was termed active surveillance in North America [3] and active monitoring (AM) in the UK [4]. It started because of the realisation that many of the localised prostate cancers identified by increasingly widespread prostate-specific antigen (PSA) testing were of low risk and posed little threat to a man's length of life [5], yet most
Recent game-changing developments
Two recent developments should provide the impetus for a clearer consensus about AS. First, the ProtecT trial found no difference in prostate cancer mortality between AM, radiotherapy, and surgery at median follow-up of 10 yr, but metastases were found in twice as many men in the AM group (6%) compared to surgery and radiotherapy (3%), which was the first robust comparative evidence about outcomes from a surveillance approach [7], [8]. Second, the PRECISION trial demonstrated that prebiopsy
Time for a “radical” change to AS?
The evidence presented above does not negate the AS approach for men with clinically localised prostate cancer. Far from it: cohort studies showing low risks of progression and death, the potential for more accurate diagnosis with mpMRI according to PRECISION, increasing understanding of the genomics and biological behaviour of prostate cancer, and the ProtecT results all confirm the importance and viability of AS/AM approaches. While the ProtecT AM protocol cannot be implemented because of the
Conflicts of interest
The authors have nothing to disclose.
Acknowledgments
Freddie C. Hamdy is Chief Investigator and Jenny L. Donovan co-Principal Investigator of the ProtecT trial. The ProtecT trial is funded by the UK National Institute for Health Research (NIHR) Health Technology Assessment Programme (96/20/06, 96/20/99) with the University of Oxford, UK, as sponsor. The authors are both NIHR Senior Investigators. The views and opinions expressed herein are of the authors and do not necessarily reflect those of the Department of Health and Social Care.
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