What is Active Surveillance for Prostate Cancer?
Active surveillance is a management approach for certain types of prostate cancer that involves closely monitoring the cancer rather than immediate treatment. The goal is to avoid unnecessary treatment and its potential side effects, while ensuring timely intervention if the cancer progresses.
Who is a Candidate for Active Surveillance?
Active surveillance is typically recommended for men with low-risk, very low-risk, and select patients with favorable intermediate risk localized prostate cancer. These varieties of prostate cancer often are slow-growing and unlikely to cause harm within a person’s lifetime. Factors considered when determining eligibility for active surveillance include:
- Gleason score (a grading system for prostate cancer) – determines the biologic aggressiveness — determined on a prostate biopsy
- Prostate-specific antigen (PSA) levels — blood test
- Clinical stage of the cancer — typically based on rectal exam
- Age and overall health of the patient
Most common eligibility criteria:
- Gleason score 3+4 = 7 or less (Grade Group 2 or less)
- Prostate-specific antigen (PSA) levels < 10
- Biopsy with <33% of biopsy core containing cancer
- No single core with > 50% cancer within the core
- Age and overall health of the patient
Benefits of Active Surveillance
Choosing active surveillance over immediate treatment offers several potential benefits:
- Avoidance of side effects: Many prostate cancer treatments, such as surgery or radiation therapy, can cause urinary incontinence, erectile dysfunction, and other complications. Active surveillance allows men to avoid these side effects unless necessary.
- Quality of life: By avoiding unnecessary treatment, men on active surveillance can maintain a good quality of life without the physical and emotional impact of undergoing treatment.
- Preservation of treatment options: If cancer progression is detected during active surveillance, treatment options such as surgery or radiation therapy are still available and can be pursued with curative intent.
What Does Active Surveillance Involve?
Active surveillance involves regular monitoring of the cancer through:
- PSA blood tests: These tests measure the level of PSA in the blood, which can indicate the presence and progression of prostate cancer. These are done every 6 months.
- Digital rectal exams (DRE): During a DRE, the doctor manually examines the prostate gland through the rectum to check for any abnormalities.
- Prostate biopsies: Periodic biopsies may be recommended to assess any changes in the cancer over time
- Imaging: although not firmly in the guidelines, prostate MRIs are often utilized to monitor disease progression
Follow-Up and Decision Making
During active surveillance, patients typically have regular follow-up appointments with their urologist to review test results and discuss any changes in their condition. Based on these findings, decisions regarding ongoing surveillance or potential treatment can be made collaboratively between the patient and their healthcare team.
What if something changes?
Active surveillance does not have to be a permanent commitment. One of the objectives is that if clinical parameters change, patients always have the option to change course and proceed with various treatment options such as radiation or surgery. Estimates typically show that about 50% of patients’ cancer progress and may ultimately require treatment at some point in their life.
Conclusion
Active surveillance is a viable option for many men diagnosed with low-risk prostate cancer. By carefully monitoring the cancer over time, men can avoid unnecessary treatment and its potential side effects while preserving treatment options for the future. If you have been diagnosed with prostate cancer, talk to your healthcare provider about whether active surveillance is right for you.
