Active Surveillance for Prostate Cancer

If diagnosed with localized prostate cancer (cancer that has not spread to distant sites such as bones and lymph nodes), disease management can take many forms, depending on the risk category of disease. Patients with low-grade, slow-growing tumors confined to the prostate gland may consider active surveillance. This involves monitoring prostate cancer in its localized stage until your doctor feels that further treatment is needed to halt the disease at a curable stage.

According to the American Society of Clinical Oncology, patients with low-risk, low-grade disease (a Gleason score of 6) can consider active surveillance. It may also be an option for patients with a Gleason score of 7. Patients within these categories may choose to postpone prostate cancer treatment because of its associated risks and side effects.

Top Candidates for Active Surveillance

You may be a candidate for active surveillance if you meet the following qualifications:

  • Your cancer is confined to the prostate.

  • Your tumor is small and is expected to grow slowly.

  • You aren’t experiencing any symptoms.

  • You have the ability to live with cancer without worry reducing your quality of life.

  • You value near-term quality of life to a greater extent than any long-term consequences that could occur.

  • You have a relatively long life expectancy and may benefit from curative local therapy if your cancer progresses.

Men with localized prostate cancer that is intermediate risk or higher and with more than a limited life expectancy usually require local treatment. They are not good candidates for active surveillance.

When it comes to active surveillance, each patient should carefully weigh the potential loss of quality of life with treatment against the possibility that the window of opportunity for cure will disappear without treatment.

Active Surveillance Testing Schedule

Medical experts offer various recommendations regarding frequency of testing and when to start treatment during active surveillance. The American Society of Clinical Oncology recommends the following periodic evaluations while under active surveillance for prostate cancer:

  • PSA testing every three to six months

  • A digital rectal exam (DRE) at least once a year

  • A prostate biopsy at least every two to five years (after the follow-up biopsy within six to 12 months of diagnosis)  

If test results or symptoms indicate the cancer is progressing, treatment is recommended with the intention of curing the disease.

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What to Know About Active Surveillance

If you’ve been diagnosed with prostate cancer, your doctor might recommend active surveillance instead of starting treatment right away. Johns Hopkins urologist Mohamad Allaf explains this approach.

How to Make Active Surveillance Safer

For carefully screened patients, active surveillance can prevent the unnecessary treatment of prostate cancer. However, this approach is not without potential side effects. Researchers are working to protect patients by helping them prevent infections from biopsies and reduce the risk of misclassified cancer.

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