More men are receiving conservative management for low-grade prostate cancer, a British study has found.

The authors used a longitudinal observational database, the British Association of Urological Surgeons Cancer Registry, to investigate patterns of care for low-risk, localised prostate cancer from 2000 to 2006. The database contains data from approximately 150 institutions and 400 urologists throughout the UK.

In all, 102,394 cases of prostate cancer were recorded during the study period. Of these, 8,861 (9%) met the criteria for low-risk, localised disease. This was defined as: Gleason score ≤ 6, with both primary and secondary Gleason grade ≤ 3, initial serum PSA < 10 ng/ml and clinical T stage T1 or T2a.

Men with low-risk disease were significantly younger than those with intermediate or high risk - 20% aged <60 and 67% <70 compared with 9% and 41%, respectively, for the intermediate- and high-risk groups.

Given the impact of radical treatment on sexual function, this emphasises the importance of at least considering watchful waiting in this younger cohort.

Men with low-risk disease were also less likely to come from socioeconomically deprived areas - 19% of cancers were low grade in the most deprived quintile, compared with 24% in the most affluent - this may reflect the higher number of asymptomatic men requesting PSA testing in more affluent areas, with disease potentially more advanced at presentation in deprived areas.

The proportion of men with low-risk disease managed by watchful waiting increased over the time of the study from 0% in 2000 to 39% in 2006. Conversely, the proportion of patients undergoing radical prostatectomy or radical radiotherapy declined, from 27% to 15% for radical prostatectomy, and from 23% to 9% for radical radiotherapy. No patients were treated with brachytherapy in 2000, but this had increased to 2% by 2006.

This trend towards increasing conservative management of low-risk disease is in marked contrast to practice in the United States. If the findings of the study represent an accurate picture of patterns of care across the UK, it would indicate a significant shift in clinical practice.