A recent report from Sunnybrook Health Sciences Centre at the University of Toronto (Yamamoto et al., Journal of Urology 195:1409-1414, May 2016) analyzed a group of 980 men who underwent active surveillance after being diagnosed with prostate cancer. Clinical and pathological features were studied to see which features were associated with the development of metastatic (spread of tumor to the lymph nodes or bones) prostate cancer. The study found that 30 patients (3.1%) developed metastases in a median of 6.3 years after diagnosis. The risk factors for developing metastases were a PSA doubling time of less than 3 years, having Gleason score 7 cancer on biopsy, or having 3 or more positive biopsies at the time of diagnosis.
The conclusion of this study was that prostate cancer patients with any of the above risk factors at the time of diagnosis should be offered active surveillance with caution. If one does choose active surveillance in this situation, further testing with MRI/newer genetic marker tests should be considered to help insure that the patient does not harbor more aggressive disease.