Low risk prostate cancer and an opportunity lost: more activity required in active surveillance

David P Smith and Gary A Wittert
Med J Aust 2018; 208 (10): . || doi: 10.5694/mja18.00209
Published online: 4 June 2018

Men who are being monitored may be more open to interventions for improving their general health and quality of life

Prostate cancer is the most frequently registered cancer in Australian men, with an estimated 17 729 new diagnoses in 2018.1 For the 25% who are diagnosed with low risk disease, active surveillance (AS) is now the recommended management strategy, as their cancer may never progress.2 Avoiding or at least postponing radical treatment reduces the quality of life risks associated with surgery or radiation therapy. However, there is no evidence-based consensus about the optimal approach to surveillance, and practices differ between countries with regard to the type, frequency, and sequence of follow-up.3 AS differs from “watchful waiting” in that it has a curative intent; watchful waiting involves less intense routine monitoring, intervening only when symptoms appear. One standard approach to AS recommends prostate-specific antigen (PSA) assessment every 3–6 months, a digital rectal examination at least once a year, and at least one biopsy within 12 months of diagnosis, followed by serial biopsy every 2–5 years.

  • 1 Cancer Council NSW, Sydney, NSW
  • 2 University of Adelaide, Adelaide, SA
  • 3 Royal Adelaide Hospital, Adelaide, SA



David Smith and Gary Wittert are collaborators on an NHMRC Centre for Research Excellence in Prostate Cancer Survivorship (CRE-PCS) (1116334). David Smith was supported by a grant from Cancer Institute NSW (15/CDF/1‑10).

Competing interests:

David Smith is a member of the Prostate Cancer Outcomes Registry Australia and New Zealand (PCOR-ANZ) steering committee. Gary Wittert is Independent Chair of the Weight Management Council of Australia and has received research support from Weight Watchers.

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