Active Surveillance for Prostate Cancer


Email Raji.Kooner@svha.org.au or call 02 8382 6980 for a confidential appointment.

Active surveillance is a very reasonable option for appropriate patients to take, it’s being increasingly used now.1

We know some prostate cancers are never going to cause a patient a problem and those prostate cancers are the ones should be monitored.2

The advantages of active surveillance include the patient maintains their quality of life, they avoid complications of treatment such as surgery and radiotherapy.

The disadvantage is that there is a small chance that the disease may progress going outside the confines of the prostate. 3

There is also potential for increased anxiety for patients.

Some patients find this very difficult to watch their cancer and also the other potential disadvantage is that there can be increased scarring with repeated biopsies making a subsequent nerve preserving procedure more difficult.4

The studies have shown that up to 30 to 40% of patients on active surveillance end up having treatment within five years either because of disease progression, PSA elevation or anxiety issues.5

The ideal patient for active surveillance should have a PSA of less than 10, a Gleeson of 6 or below, less than three cores of their prostate biopsies positive and no significant PSA velocity.6

Ideally older men are very well suited to this option and perhaps young men who want to maintain their quality of life.

It is very important however to be continued to be monitored.

We monitor patients by doing a PSA every three months and a biopsy again at one year and perhaps every one to two years after.

There’s also an evolving role of the use of MRI in this situation.7

So active surveillance is an option that I discuss with all my patients and a large percentage of them do choose active surveillance and we monitor them very carefully.

If the disease progresses we can always intervene and treat the patient.

It’s not what is normally known as wait and watch, which is just leaving the cancer alone, it’s active surveillance with intervention when required.

References

1. Active Surveillance for Prostate Cancer: A Systematic Review of the Literature - Marc A. Dall’Era, Peter C. Albertsen, Christopher Bangma, et al - European Urology, Volume 62, Issue 6, December 2012, Pages 976-98 - https://www.sciencedirect.com/science/article/abs/pii/S0302283812006914
2. Localized prostate cancer: Low-risk prostate cancer: Active surveillance or treatment? - Institute for Quality and Efficiency in Health Care (IQWiG) 2006 - https://www.ncbi.nlm.nih.gov/books/NBK487255/
3. Active surveillance for prostate cancer - Ian M Thompson, Laurence Klotz - JAMA 2010 Dec 1;304(21):2411-2 - https://pubmed.ncbi.nlm.nih.gov/21119090/
4. Current status of active surveillance in prostate cancer - Mun Su Chung and Seung Hwan Lee - Investigative and Clinical Urology 2016; 57(1): 14-20 - https://synapse.koreamed.org/articles/1088037
5. Long-term follow-up of a large active surveillance cohort of patients with prostate cancer - Laurence Klotz, Danny Vesprini, Perakaa Sethukavalan, et al. - J Clin Oncol - 2015 Jan 20;33(3):272-7 - https://pubmed.ncbi.nlm.nih.gov/25512465/
6. Treatment of localized prostate cancer: when is active surveillance appropriate? - Peter C Albertsen - Nat Rev Clin Oncol. 2010 Jul;7(7):394-400 - https://pubmed.ncbi.nlm.nih.gov/20440282/
7. The current role of MRI for guiding active surveillance in prostate cancer - Guillaume Ploussard, Olivier Rouvière, Morgan Rouprêt, et al - Nature Reviews Urology - https://www.nature.com/articles/s41585-022-00587-0