Active surveillance of prostate cancer

Active Surveillance of Prostate Cancer is a management strategy for prostate cancer that involves closely monitoring the patient's condition without immediate active treatment. This approach is typically recommended for men with low-risk, localized prostate cancer, where the disease is not causing any symptoms and is expected to grow very slowly.

Overview

Active surveillance aims to avoid or delay the side effects associated with treatments such as surgery, radiation therapy, and hormone therapy, which can significantly impact the patient's quality of life. Instead of immediate treatment, patients undergo regular monitoring, which includes prostate-specific antigen (PSA) tests, digital rectal exams (DRE), and possibly MRI scans or prostate biopsies. The goal is to intervene with active treatment only if the cancer shows signs of progression.

Criteria for Active Surveillance

The criteria for selecting active surveillance for prostate cancer patients may vary slightly among different medical institutions, but generally include:

• Gleason score of 6 or less
• PSA level less than 10 ng/mL
• Clinical stage T1c or T2a (cancer is confined to the prostate)
• A small volume of cancer (often defined as three or fewer prostate biopsy cores containing cancer, with cancer making up no more than 50% of any core)

Monitoring Protocol

The monitoring protocol for active surveillance typically involves:

• PSA test every 3-6 months
• Digital rectal exam (DRE) every 6-12 months
• Repeat biopsy within the first year and then at intervals depending on the results and changes in other tests

Advantages and Disadvantages

Advantages:

• Avoids or delays the side effects of active treatment
• Allows patients to maintain their quality of life
• Reduces the risk of overtreatment for slow-growing cancers

Disadvantages:

• Requires regular and possibly invasive testing
• May cause anxiety or stress due to living with untreated cancer
• Risk that the cancer could grow or spread between check-ups, potentially reducing the chance of cure

Decision Making

Choosing active surveillance involves careful consideration of the potential risks and benefits. It is important for patients to discuss with their healthcare team to understand their specific situation, including their cancer's characteristics, overall health, age, and personal preferences.

Conclusion

Active surveillance of prostate cancer offers an alternative to immediate treatment for men with low-risk, localized prostate cancer. By closely monitoring the disease, patients can avoid or delay the side effects of treatment while maintaining the option to intervene if the cancer shows signs of progression.