Active Surveillance for Prostate Cancer

Active surveillance is a management strategy for men with low-risk prostate cancer, which involves closely monitoring the disease with regular check-ups and tests, rather than immediately treating it with surgery or radiation.

Goals of Active Surveillance

• To avoid or delay the side effects of treatment, such as urinary incontinence, erectile dysfunction, and bowel problems
• To preserve quality of life by avoiding unnecessary treatment
• To monitor the cancer for any signs of progression or aggressiveness, at which point treatment can be initiated

Eligibility Criteria

Men with low-risk prostate cancer are typically eligible for active surveillance. Low-risk prostate cancer is defined as:

• PSA (prostate-specific antigen) level less than 10 ng/mL
• Gleason score of 6 or less
• Clinical stage T1 or T2a
• Less than 3 positive biopsy cores
• Less than 50% cancer involvement in any single core

Components of Active Surveillance

• PSA testing: Regular PSA tests to monitor for any changes in PSA levels, which can indicate cancer progression
• Digital rectal exams (DRE): Regular DREs to check for any abnormalities or changes in the prostate gland
• Prostate biopsies: Repeat biopsies every 1-3 years to monitor for any changes in cancer grade or extent
• Imaging tests: Regular imaging tests, such as MRI or CT scans, to monitor the prostate gland and surrounding tissues

Risks and Benefits

The benefits of active surveillance include avoiding unnecessary treatment and preserving quality of life. However, there are also risks, including:

• Progression of cancer: The risk that the cancer may progress or become more aggressive over time
• Delayed treatment: The risk that delaying treatment may reduce the effectiveness of subsequent therapy
• Anxiety and uncertainty: The emotional burden of living with untreated cancer and the uncertainty of disease progression

Follow-up Schedule

The follow-up schedule for active surveillance typically includes:

• PSA tests every 3-6 months
• DREs every 6-12 months
• Prostate biopsies every 1-3 years
• Imaging tests as needed

Conversion to Treatment

Men on active surveillance may need to convert to treatment if:

• PSA levels rise significantly
• DRE findings become abnormal
• Biopsy results show cancer progression or increased aggressiveness
• Imaging tests reveal changes in the prostate gland or surrounding tissues