Active surveillance (expectant management) for men with prostate cancer is the postponement of immediate therapy, with definitive treatment (such a brachytherapy, external beam radiation or surgery) if there is evidence that the patient is at increased risk for disease progression. Active surveillance is an accepted option for the initial management of carefully selected men with localized, well-differentiated prostate cancer thought to be at low-risk for progression
This means that men undergo periodic evaluations including PSA tests, digital rectal examinations, and prostate biopsies.
Active surveillance is only offered as an option to patients who show very low risk for cancer growth, however there are risks associated with this delayed treatment option.
While it is important to work with your doctor to discuss these guidelines in the context of your own specific health situation, it is also important to check your feelings: patients need to have the correct mindset for this option, as knowledge of having cancer and not treating it, can cause anxiety.
Who are the best candidates for Active Surveillance?:
- Men who have the ability to live with cancer without worry reducing their quality of life
- Men who are willing to commit to the serial exams, PSA’s and biopsies
- Men who are most concerned about the potential side effects of treatments
- Men who value near term quality of life to a greater extent than any long term consequences that could occur
Each man should carefully weigh the potential loss of quality of life with treatment (radiation or surgery), against the possibility that the disease may progress requiring more aggressive therapy.
Active Surveillance guidelines:
- Stereotactic Transperineal Mapping Biopsy to ensure comprehensive results
- Gleason score 3+3=6 or 3+4=7 (if very low percentage of core)
- PSA less than 10
- No more than 2 positive cores or cancer involving no more than 50% of any core
- Measure the aggressiveness of the cancer
- PSA every 3-6 months
- DRE at least once a year
- Prostate Biopsy every 1-2 years (as determined by your oncologist)
If there is evidence that the cancer is growing or has changed, treatment is immediately recommended with the intention of curing the disease.