Multicenter prospective cohort study of long-term outcomes with protocol-directed active surveillance for prostate cancer

Outcomes from protocol-directed active surveillande for favorable-risk prostate cancers are needed to support decision-making. The prospective Canary Prostate Active Surveillance Study characterized long-term oncological outcomes of 2155 patients with localized prostate cancer undergoing protocol-direced active surveillance. The median follow-up was 7.2 years. The 10-year incidence of upgrading at biopsy and definitive treatment were 43% and 49%, respectively. The 10-year incidence of metastasis and prostate cancer mortality were 1.4% and 0.1%, respectively. There was no significant difference in adverse outcomes in men treated within the first 2 years of surveillance versus later on. The authors conclude that protocol-directed active surveillance is a safe management strategy for avoiding overtreatment and preventing undertreatment in prostate cancer.