Active Surveillance of Prostate Cancer

Not all Prostate Cancers that are detected are considered to be clinically significant. In such cases, the doctor may recommend simply Active Surveillance of cancer by routine follow-ups, if treatment is not yet needed.

Active surveillance aims to prevent the overtreatment of clinically insignificant cancers that may never cause you a problem.

If the prostate cancer appears to be potentially insignificant then it is monitored periodically with

• PSA Tests, clinical assessment (+/- DRE)
• Prostate MRIs and
• Repeat Surveillance Biopsies.

If it appears that the cancer is progressing then active primary therapy can be performed at that stage.

Advantages of Active Surveillance of Prostate Cancer

The advantages of Active Surveillance of Prostate Cancer are:

• Aims not to over-treat a potentially clinically insignificant cancer.
• Avoids the treatment associated side effects and complications.
• Quality of life is maintained.
• Decreased initial costs.

Disadvantages of Active Surveillance of Prostate Cancer

The disadvantages of Active Surveillance of Prostate Cancer are:

• Prostate examination, prostate biopsy and PSA tests may not accurately determine whether the cancer is indeed insignificant from the outset.
• Chance of missed opportunity for cure.
• Cancer may progress or spread while on surveillance so that it may require more extensive treatment or become incurable.
• Nerve-sparing at subsequent prostatectomy may be more difficult which may reduce the chance of continence or potency preservation after surgery.
• The anxiety associated with living with untreated cancer.
• The need for intense follow-up.

The criteria for active surveillance are yet to be fully defined but generally include low volume low-grade disease.

Active surveillance protocols continue to be refined and are yet to be fully validated.

Moreover, the timing of when to intervene is not clearly defined but is based on a number of factors (ie. patient age, comorbidities, preference, disease progression). Studies are currently underway to determine what constitutes disease progression and when to intervene. However, overall, it seems to be a safe and non invasive option for men with a very small risk of metastasis and mortality.