Treatment-free survival.

This Swedish cohort study of 23,655 men undergoing active surveillance (68%) or watchful waiting (32%) aimed to describe the risk and benefits of such decisions. First up, the risk: those diagnosed with intermediate risk prostate cancer younger than age 60 had the highest risk of subsequently dying of prostate cancer (12-15%). Conversely, those diagnosed with low risk prostate cancer older than 65 carried a 3-5% risk of dying of prostate cancer. But what’s the benefit? Clearly it’d be great if no one died of prostate cancer. Here the authors posed the practical question of how many years of each man’s remaining years of life were free from prostate cancer treatment. The mean was 12 of 25 years (48%) for very low-risk PC, 9 of 25 years (36%) for low-risk PC, and 7 of 25 (29%) for intermediate-risk PC. At either end of the spectrum above, those diagnosed with intermediate risk prostate cancer younger than age 60 were treatment-free 29-33% of their remaining life, while those diagnosed with low risk prostate cancer older than 65  were treatment-free 62-77% of their remaining life. | Ventimiglia, JAMA Netw Open 2022