Active surveillance for prostate cancer
Active surveillance may be a treatment option for some men with prostate cancer that has a very low risk of progressing. Active surveillance means the healthcare team watches the cancer closely. Treatment is given if there are any signs of the tumour growing or showing signs of an increased risk of progression.
Many men diagnosed with prostate cancer will not need to have treatment as soon as they have been diagnosed. Most prostate cancers are slow-growing tumours, and many remain confined to the prostate gland. Older men diagnosed with this type of prostate tumour are more likely to die from other coexisting diseases rather than from prostate cancer. They are often unlikely to notice any signs or symptoms of their cancer for many years. Active surveillance is usually the treatment of choice in older men and those with significant medical problems (especially if life expectancy less than 10 years). However, it is also suitable for many healthy, younger men.
Active surveillance is not known to have negative effects or to reduce long-term survival.
Active surveillance may be a treatment option for men with prostate cancer who:
- have low-grade (Gleason score 6) or sometimes intermediate-grade (Gleason score 7) prostate cancer that is confined to the prostate (early stage) and is considered low (favourable) risk
- prefer not to have immediate treatment for prostate cancer, to avoid side effects and preserve their quality of life
During active surveillance, regular tests will be done about every 3 to 6 months to monitor the prostate cancer. This can vary depending on the individual situation. Tests may include:
- prostate-specific antigen (PSA) test
- physical examination, including a digital rectal examination (DRE)
- prostate biopsy
- bone scan, chest x-ray or CT scan, depending on signs and symptoms
- MRI of the prostate (in some cases)
Treatment such as surgery or radiation therapy is started if:
- the PSA level consistently rises over time
- the Gleason score increases on follow-up biopsies
- there are symptoms and tests that show the cancer is progressing
Some men may find it too stressful to have their prostate cancer watched or monitored without active treatment. For these men, immediate therapy may be the preferred option.
|Advantages of active surveillance||Disadvantages of active surveillance|
avoids unnecessary treatment and side effects
risk of spread and missed chance of a cure
quality of life unchanged
frequent follow-up visits and tests
It is very important for a man with prostate cancer to be well informed about the details of his diagnosis and treatment options as well as the potential side effects. This allows him to choose the treatment option that is best for him.