Active surveillance of prostate cancer, the most common cancer in men and the second leading cause of cancer death for men in the United States, can reduce the potential for and risks of overtreatment, according to a study published in the October issue of Surgical Clinics of North America.

In a review of the epidemiology of prostate cancer, results of screening trials, and current strategies used to avoid overdiagnosis and overtreatment, William Tabayoyong, MD, PhD, and Robert Abouassaly, MD, MSc, assessed screening with the prostate-specific antigen (PSA) test considering recent changes in guidelines. 

PSA has been validated as a marker for prostate cancer, but the screening test is not specific for prostate cancer and cannot discriminate between low-grade and high-grade disease. Although PSA screening led to lower mortality, the authors noted that use of the test may have also led to overdiagnosis and overtreatment of clinically insignificant cancers. In 2012, the U.S. Preventive Services Task Force (USPSTF) issued a statement recommending against the use of the PSA test, citing evidence that the risks of screening outweighed the benefits. 

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Since the release of the USPSTF statement, Drs. Tabayoyong and Abouassaly found that the use of the PSA test for prostate cancer screening has decreased. Their results indicate that active surveillance could reduce overtreatment by nearly 50% at 15 years and that men under active surveillance are not at immediate risk of death from prostate cancer if therapy is deferred until the cancer progresses. 

“While PSA screening has reduced prostate cancer mortality, it is not very accurate and has led to overdiagnosis and overtreatment,” the authors said. “Because prostate cancer can be slow-growing, we recommend active surveillance, a treatment approach during which patients are monitored and tested at regular intervals.”