The Urology Group
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October 10, 2017

Active Surveillance for Prostate Cancer

By: Patrick Wirtz

Did you know that getting tested for prostate cancer doesn't always mean seeking immediate treatment? Each patient is different and what is “best” for one may not be “best” for another.

Active surveillance is a decision not to treat prostate cancer at the time of diagnosis. Active surveillance may be used in a couple of very different clinical settings. 

Some men diagnosed with prostate cancer may be quite elderly, or in frail overall health. A basic tenet of prostate cancer treatment is that men who do not have a ten-year life expectancy, either due to age or poor overall health, may not need treatments such as surgery or radiation therapy at all. These patients may simply be observed. In this setting, the urologist will follow the patient’s PSA level and overall health periodically. If the patient has been deemed a poor candidate for potentially curative treatment based on age or health, and the cancer progresses, it is common to employ hormone therapy, which is almost always effective at slowing the growth of prostate cancer.

Recent research also indicates that immediate prostate cancer treatment may be deferred for a subgroup of healthy men with very low-risk prostate cancer. While experts differ as to who exactly may qualify for this form of active surveillance, most authorities suggest that it is appropriate for men with no more than one or two positive biopsies of Gleason 6 cancer, as long as there is not too much cancer in the positive biopsy core(s). Since these cancers are small and slow growing, it is believed that these men are generally at low risk for spread of cancer while un­der active surveillance. Men may choose active surveillance as opposed to treatment in order to avoid the inconvenienc­es and potential side effects of treatment.

If a man decides not to pursue immediate treatment, a critical element of active surveillance for healthy men with very low-risk prostate cancer is appropriate long-term follow-up, particularly follow-up prostate biopsies. Relying on follow-up PSAs alone (without biopsies) is not enough.

If you pursue a course of active surveillance, your urologist will advise you as to the timing of follow-up PSA testing and prostate biopsies. About 25% of healthy men with very low risk prostate cancer who qualify for and pursue active surveillance will eventually require treatment due to cancer growth, as determined by their follow up PSA and prostate biopsy results.

There are many factors to consider when deciding which treatment to choose for your prostate cancer. These decisions should be made in conjunction with your doctors, which include urologists and radiation oncologists, and you may wish to talk with your primary care physician, family, and friends as well.

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