Prostate Cancer: Surveillance is Effective Way to Manage Disease

The Canary Pass trial shows the effectiveness of the active surveillance protocol in the real world.

The study was conducted with more than 2,300 patients across 10 treatment centers in North America. Patients were recruited between 2008 and 2022, with an average follow-up period of 7 years. The majority were white (83%), while a small proportion were Black (7%).

Researchers found that using the protocol effectively managed the cancer and reduced overtreatment.

Ten years after an initial diagnosis, nearly half (49%) of all participants did not experience cancer progression, nor did they receive treatment. Within the entire cohort, less than 2% developed metastatic cancer. Less than 1% of patients died from the disease.

“It’s nice to see a longer follow-up, which is presented here. That really just reassures those of us in prostate cancer that we’re very much on the right track of not immediately treating low-grade prostate cancer,” Geoffrey Sonn, MD, an Associate Professor of Urology at Stanford Medicine who wasn’t affiliated with the research, told Healthline.

Lorelei Mucci, MPH, ScD, Director of Strategic Research Partnerships at the American Cancer Society, told Healthline, “All of this together is providing incredibly important outcome information that will be really useful both for patients and clinicians in making decisions about clinical care and prostate cancer.” Mucci wasn’t involved in the research.

Active surveillance of prostate cancer is a means of monitoring cancer growth in low-risk patients. Doctors use a variety of tests and diagnostics at their disposal to keep tabs on the cancer and determine if the patient should undergo treatment to remove the cancer.

However, there is no standard for what constitutes active surveillance in terms of how frequently a patient should be undergoing testing. One of the strengths of the Canary PASS protocol is that it establishes a clear testing schedule.

“What this field of active surveillance has needed, which this study has done, is to provide a very clear protocol of what you should do and when. It’s a very structured protocol, and what it shows is you can apply this protocol well across these 10 sites, patients and their clinical team, and have high adherence,” said Mucci.

The Canary Pass protocol involves PSA testing, prostate biopsy, and other optional tests including MRI and biomarker tests.

• PSA testing was initially conducted every 3 months. However the protocol changed in 2020; it is now recommended every 6 months.
• Prostate biopsies took place at 6 months, then again at 1 year after diagnosis. After the first two years, the frequency of biopsies drops to once every two years.
• MRI and biomarker tests are considered optional to the protocol and can be performed at the doctor’s discretion.

“The most important biopsy is the one within a year after diagnosis, often called a ‘confirmatory biopsy.’ Some clinicians do not consider a patient being on active surveillance until after the confirmatory biopsy, yet a few studies have shown that as many as half of people diagnosed with low-risk cancer do not receive a confirmatory biopsy,” said Newcomb.

Prostate cancer is second only to skin cancer as the most common form of cancer among men. It is also the second-leading cancer death for men, behind lung cancer. About 1 in 8 men will be diagnosed with prostate cancer during their lifetime.

However, prostate cancer is frequently slow-growing, so slow in fact that it may never require treatment during a patient’s lifetime.

“Prostate cancer is an interesting cancer and somewhat unique among malignancies because there’s so much variability in the type of cancer that patients have,” said Mucci.

The cost of unnecessary treatment, both in dollars and in risk to patients, has become a much larger part of the discussion around prostate cancer screening in recent years.

Screening guidelines remain a complex issue. Both the American Cancer Society and the US Preventive Services Task Force both recommend discussing screening tests with a doctor between the ages of 50-55.

“I hope that both patients and their doctors are reassured that favorable risk cancer does not need to be treated right away. I hope that our results increase the national acceptance of active surveillance instead of immediate treatment for prostate cancer,” said Newcomb.

For patients with low-grade prostate cancer, active surveillance is effective for management of the disease.

Active surveillance utilizes a variety of tests to determine cancer growth and to determine if a therapy, such as surgery, is needed.

For slow-growing prostate cancer active surveillance may reduce unnecessary treatments and costs.