Active surveillance is a way of managing localized prostate cancers, similar to but different from watchful waiting, which has had excellent long-term results in some patients.
The active surveillance approach began in the 1990s in selected patients with localized prostate cancer. It is sometimes called “expectant management with 3curative intent.” The goal is to watch the disease closely and offer curative treatment at the first sign of disease progression, long before symptoms arrive or other overt signs of tumor growth are apparent.
Most localized cancers are slow growing and may never pose a threat to life, while others may progress into aggressive cancers. Thus, many newly diagnosed prostate cancer patients are treated when they may not necessarily need to be at that time. Prostate cancer treatments include surgery, radiation therapy and ablative therapies. Surgery and radiation can be effective treatments, but they are associated with side effects that may include incontinence, erectile dysfunction, bowel dysfunction and lower–urinary tract symptoms.
The challenge is determining which patients with localized prostate cancer will benefit most from active surveillance and which patients may benefit from immediate treatment. There is currently no accurate way to predict which cancers will act aggressively.
Several studies have been conducted around the world using active surveillance, and their outcomes have been very good. In general, this approach of selecting certain men to have treatment in a delayed manner, and sometimes not at all, is associated with low rates of disease progression and death.
The ability to choose which patients will benefit from treatments and which can avoid treatment is still being studied. The hope is that doctors will be able to use markers of disease risk at the time of diagnosis to make this determination.
“Active surveillance appears safe and has been underutilized in men with low-risk prostate cancer. We are currently investigating improved ways to predict prostate cancer behavior and are leading a national study in active surveillance,” says medical oncologist, Dr. Dan Lin.
Age is not necessarily the primary driving force to recommend active surveillance or watchful waiting. Primary disease attributes such as grade, stage and prostate-specific antigen (PSA) play major roles in treatment recommendations.
Prostate cancer generally is slow growing. It can take 10 or more years for it to spread enough to threaten your life, so if you have a life expectancy of 10 years or less, it may not make sense to treat your cancer aggressively.
Active surveillance doesn’t mean sending you home to do nothing, though. If you choose this option, you will see your urologist frequently for PSA tests and checkups. Your doctor may recommend that you have a PSA test every three months to see if your PSA levels are higher, with another prostate biopsy at the end of six months of watchful waiting.
Your doctor will continue to monitor your condition in this way and not recommend treatment unless your PSA starts going up.
Active surveillance may be an appropriate alternative to aggressive medical treatment for older men who have a life expectancy of less than 10 years, and it may sometimes be appropriate for younger men as well.
Active surveillance may be appropriate for younger men who:
- Have a small cancer
- Have a low-grade prostate cancer
- Have a low PSA
- Are reluctant to undergo aggressive treatment
For these men, regular PSA tests and digital rectal exams are recommended, as well as occasional biopsies. If the cancer progresses, then surgery or radiation can be used to treat it at that time.