prostate-report.org

Questions regarding selection of patients for active surveillance at VA medical centers

A recent study at University of California-San Diego, reports that patients in the SEARCH database who would theoretically have been eligible for active surveillance (AS) for low-risk prostate cancer were actually at increased risk for recurrence if they were of older age, obese, or had been exposed to Agent Orange (presumably in Vietnam in most cases). .

This research has important implications related to the selection of patients for active surveillance, particularly within the VA health system. The report conclusion, published in Urology, clearly suggests men managed within this system, even if they meet standard criteria for active surveillance, have increased risk for progressive disease if they belong to above risk factor categories.

But it is also worth noting that this group contained a high percentage of African American patients, and this may also be a key factor in understanding their risk for progressive disease.

However, the main question that will need to be addressed in assessing men for active surveillance within VA protocols is whether the mentioned risk factors should preclude patients from enrollment or whether they simply needed to be closer monitored in order to assure that curative therapy can be offered at an appropriate time.