July 26, 2017

What is active surveillance for prostate cancer?

Active surveillance means monitoring slow-growing prostate cancer instead of undertaking radical treatments such as surgery or radiation right away. The goal is to delay surgery, radiation or other measures for as long as possible in order to avoid the side effects associated with these treatments.

Why is active surveillance an option?

Some forms of prostate cancer grow slowly. Some older men who receive a prostate cancer diagnosis might not need treatment at all during their lifetime. Younger men may be able to delay treatment and, in doing so, delay the side effects of the treatment until later in life.

Active surveillance for men who have received a prostate cancer diagnosis involves checking the prostate regularly to see if the cancer has gotten to the point where treatment is necessary. This usually means getting a PSA test (a blood test) and receiving a digital rectal examination (DRE) twice per year. Your doctor may also want to do a prostate biopsy annually to make absolutely certain that the cancer has not grown the point where it could become dangerous.

When would your doctor recommend active surveillance?

Active surveillance is an option when the cancer is in its early stages of development. It should not be causing any symptoms, and it should be slow growing. Doctors can measure the growth rate by seeing how much the cancer looks like normal prostate tissue. They assign the cancer a number, called a Gleason score. The "score" is between 1 and 10, with lower numbers assigned to less aggressive forms of cancer that may not need immediate treatment.

Your doctor will also test to make certain that the cancer has not spread to other body parts. They will look at your PSA test results, as well as other factors, to measure the danger of the cancer spreading.

Early studies have shown that more half of the men who are good candidates for active surveillance have to undergo treatment at some point in their lives. Men over 70 may be good candidates for active surveillance if their cancer is of the slow growing variety.

Some men are willing to live with the side effects of prostate cancer treatment no matter what their long term prognosis might be. They do not want to risk cancer progressing beyond the "local stage" where it affects only the prostate. With treatment, the five year survival rate for local prostate cancer is nearly 100%. It should also be noted that with "regional stage" prostate cancers, when the cancer has already spread to nearby tissue, the five year survival rate is still very high. This could be an argument both for and against active surveillance.

Decisions about active surveillance also highlight the importance of having a good relationship with your doctor so that you can come to a decision about how to deal with your prostate cancer. A good doctor will take your feelings into consideration when coming up with a treatment strategy for your cancer.


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