What is active surveillance?
Because the prediction of clinically insignificant disease is problematic and inaccurate, an alternative strategy has been developed that allows a patient to enter into an expectant management protocol with rigorous monitoring and the option of curative therapy, should signs of progression develop. This is referred to as active surveillance. Active surveillance allows a patient to delay potential treatment related side-effects. Patients have the added hope that when treatment is necessary, more effective and less toxic ones may be available.
Is active surveillance a reasonable choice for you?
You may want to consider active surveillance if your cancer is low risk or if you have significant comorbidities that are likely to limit your life expectancy. Updated guidelines (see NCI Bulletin January 2010) from an NCCN panel urge clinicians to offer active surveillance to their patients with the following low risk parameters.
Low risk with expected survival: Less than 10 years
Very low risk with expected survival: Up to 20 years
- Tumor stage: T1-T2a
- Tumor grade: Gleason score ≤6
- PSA level < 10 ng/mL
- < 3 positive biopsy cores, ≤ 50% cancer in each core
How to monitor your active surveillance?
Many prostate cancer physicians now offer active surveillance to low risk patients. The protocol for monitoring these patients varies but most include elements of the following:
- PSA every 3 months
- PCA3 and digital rectal examination every 6 months
- Biopsy after one year and every two to three years thereafter
- Annual imaging with color Doppler ultrasound or endorectal MRI can be considered though neither is widely available
When to seek treatment?
A general consensus has developed around factors such as pathologic progression (increase in Gleason score and/or number of cores involved with cancer), rapid PSA progression (defined as short PSA doubling time), and clinical progression on digital rectal exam.
In addition, a significant number of patients (25-30%) decide to withdraw from active surveillance and cross-over to radical therapies for various reasons such as “anxiety”or“patient preference.”
Active Surveillance For Favorable Risk Prostate Cancer: What Are The Results, and How Safe Is It?
Active Surveillance with High Resolution Color-Doppler Transrectal Ultrasound Monitoring
Progress in Prostate Cancer: Targeted Biopsies and Active Surveillance
A Patient’s Perspective: First Do No Harm — Active Surveillance May Be the New Gold Standard
Active-Surveillance.com video interviews and Blog