Can A Man Be Too Young For Active Surveillance in Management of Low-Rise Prostate Cancer?

There is a “conventional wisdom” that careful monitoring through so-called “active surveillance” as a way to manage low-risk prostate cancer is only a good idea for older men in their 60s and 70s, and that younger men with low-risk prostate cancer are better off having immediate radical treatment. By “better off” we mean that there’s a better chance at cancer control, or that the common side effects of treatment, particularly incontinence and impotence, will be milder if treated earlier.

However, when one turns a spotlight on that conventional wisdom, it’s not so clear that it holds up under scrutiny.

For starters, it’s important to understand how slowly low-risk prostate cancer typically progresses in young men, even without active surveillance; that is, even without any intention to treat if the cancer progresses. Based on the Memorial Sloan-Kettering Cancer Center male life expectancy survey, we can see that for a 45-year-old man in excellent health diagnosed with a Gleason score of 3 + 3, a PSA of 4 ng/ml, and nothing felt on a digital rectal exam, he has a zero chance of dying of prostate cancer in the next 10 years, and a 4 percent chance of dying of something else. Even if he lets it go for 15 years, he still only has a 3 percent chance of dying of prostate cancer, and an 8 percent chance of dying of something else.

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