What is active surveillance?
Active surveillance is active monitoring of your prostate cancer.
There is no standard protocol. Each hospital around the world practices a different approach.
Irrespective of the protocol, your regular tests will include a PSA blood test, an MRI prostate, and possibly a rectal exam. Rectal exams are still performed in some centres, but with the availability and high reliability of MRI scans, many centres do not perform them.
In the past, prostate biopsies were regularly scheduled; however, nowadays, prostate biopsies are recommended based on MRI findings or PSA trajectory.
What would a typical prostate cancer active surveillance protocol look like?
First-year
PSA every three to four months
MRI scan after 12 months.
Second year and onwards
PSA every six months
MRI scan every 18 to 24 months.
Why have you been offered active surveillance?
Your prostate cancer has been classified as low-risk (Gleason 6) because it is contained in the prostate.
Treatments for prostate cancer, like radiotherapy or radical prostatectomy (surgery), high-intensity frequency ultrasound (HIFU), NanoKnife, and others, carry an element of toxicity. These side effects may be long-term, with a negative impact on the quality of life of men.
What is the reasoning behind active surveillance?
Numerous published studies showed that many men with low-risk, low-volume prostate cancer contained in the prostate gland that underwent treatment had no significant benefit compared to those surveyed. Most men on active surveillance won’t need therapy in their life.
Can a man opt-out or become eligible for active treatment?
If there are signs your PSA is rising or an MRI prostate shows any change, you will be asked to undergo a prostate biopsy. If there is a progression of the disease, you will be offered treatment.
Suppose the burden of the thought of having cancer is too heavy on one’s shoulder and afflicts the daily routine and sleep or worsens the anxiety with which one cannot function. In that case, you can discuss with your surgeon and caring team to opt out and explore active treatment (surgery or radiotherapy or HIFU or NanoKnife).
Is there a risk that prostate cancer spreads without being picked up during active surveillance?
The tests used for active surveillance are reliable. However, there is still a tiny chance that prostate cancer will spread outside the gland before being identified, and active treatment available might not be any more viable.
How many men are on active surveillance in the UK?
2 out of 5 men diagnosed with prostate cancer are on active surveillance.
Is it normal to get stressed while waiting for your results?
It is quite common to get sensitive, stressed, anxious and disturbed sleep until you are waiting for the results. The term PSAdynia was coined for this.
Trying to hide your feelings and isolating your thoughts mounts pressure that can become unbearable. Ensure you have an open conversation with your loved ones and a caring urological team. There is plenty of help out there, like Prostate Cancer UK.
Can I change my health while I am on active surveillance?
Generally, men with a leaner body weight tend to do better than those who are overweight or obese.
A balanced diet and exercise are essential. Quit smoking and reduce your alcohol intake. Always remember, should treatment be needed, you will be in the best physical health.
Many men increase their lycopene intake (found in cooked tomatoes, pomegranate, etc.).
Questions to ask your prostate cancer nurse or urologist
How often will I have my PSA level checked?
The PSA blood test is unreliable; how will you evaluate my PSA to determine further management?
How often will my appointments be?
Will I have a rectal exam each time?
When will you perform prostate biopsies?
What are the advantages and disadvantages of active surveillance?
If my cancer progresses, what treatments could I be offered?
Active surveillance pros and cons
Advantages
You would not receive invasive treatment, so you’ll avoid the side effects of these treatments.
If your prostate cancer was found to be growing or progressing during follow-up, treatment can be offered after re-staging.
Disadvantages
Prostate biopsies may be recommended; some men find these uncomfortable or painful.
Rarely, prostate cancer might progress more rapidly than anticipated, restricting active treatment options. As stated, this is really uncommon.
A person’s health could alter during the active surveillance period, and based on your medical condition, you may not qualify for some treatments.
Onset or worsening anxiety can impact a man’s life, as some people would feel better if something is done. Discuss these feelings and treatment options with your doctor and caring team.
It is always a personal choice. Make sure you have all the information in hand to enrol on active surveillance. There’s usually no pressure to come to a decision.
