A recent study highlighted that just 15 per cent of men with early age prostate cancer in North Carolina chose strict observation instead of treatment and followed the recommended monitoring guidelines.

The study was discussed in the ASCO Annual Meeting. The research findings were drawn from an analysis of 346 men newly diagnosed between 2011 and 2013 with low or intermediate-risk of prostate cancer in North Carolina. Researchers analysed how often men received biopsies and other tests according to the guidelines from the National Comprehensive Cancer Network.

Ronald C Chen, one of the researchers said, "Active surveillance has rigorous guidelines - people need regular PSA tests, they need prostate exams, they need prostate biopsies so you can watch cancer very closely, and you don't lose the opportunity to treat cancer when it starts to grow."

"One of the main findings of this study is that in this population-based cohort, not in a clinical trial or purely academic setting, only 15 per cent of patients in active surveillance received recommended monitoring," Ronald added. Data have shown that active surveillance is safe, but the researchers note that those data have been drawn from clinical trials or studies in large academic institutions.

To evaluate monitoring in a broad population, they studied a group of patients from North Carolina to determine if they adhered to NCCN active surveillance guidelines, which recommended prostate-specific antigen (PSA) tests at least every six months, digital rectal exams annually, and a repeat biopsy within 18 months of diagnosis.

In the first six months, 67 per cent of patients had received a PSA test, and 70 per cent received a digital rectal exam. Just 35 per cent received a biopsy within the first 18 months. Across all types of tests by 24 months, only 15 per cent of patients received monitoring compliant with the guidelines.

Researchers also reported that they did not find any variables, such as income, race or age, linked with whether or not patients would adhere to the monitoring guidelines. The findings led researchers to call for more research into outcomes for active surveillance outside of controlled studies.

"This raises the question of whether we need to investigate whether active surveillance is a safe option when patients do not receive routine monitoring," Chen said.

"Our goal is not to reduce the number of patients choosing active surveillance; rather, the results of this study should increase awareness and efforts to ensure that active surveillance patients are monitored rigorously," he added.

Researchers also analysed trends linked to patients who stopped active surveillance and started treatment. In addition to finding that disease progression motivated patients to switch to treatment, they found that a patient's level of anxiety was linked to whether or not they stopped active surveillance and switched to treatment.