Active surveillance is a monitoring strategy for localised (early) prostate cancer, allowing patients to avoid immediate treatment. This approach involves regular tests to check on cancer progression. The primary goal is to delay or avoid unnecessary treatment and its associated side effects unless tests show that the cancer is growing. If there are signs of progression, curative treatment options will be offered.
Active surveillance might seem counterintuitive, but localised prostate cancer often grows slowly, with a low risk of spreading. Studies definitively indicate that approximately 50% of men on active surveillance for low-risk prostate cancer can successfully avoid treatment for at least ten years.. Many men under active surveillance will never require treatment.
What is watchful waiting the same as Active Surveillance?
Active surveillance differs from watchful waiting, another method of monitoring prostate cancer. The primary difference is that active surveillance involves regular testing with the intent to offer curative treatment if necessary, whereas watchful waiting focuses on symptom management.
Who is Suitable for Active Surveillance?
Active surveillance is appropriate for men with Cambridge Prognostic Group (CPG) 1 or 2 localised prostate cancer, indicating the cancer hasn't spread beyond the prostate and has a low risk of spreading. It may also be suitable for men with CPG 3 localised prostate cancer who wish to delay treatment.
Active surveillance is not recommended for men with more aggressive prostate cancer (CPG 4 or 5) due to the higher risk of spreading. For these men, more immediate treatment options are considered.
What are the Advantages and Disadvantages of Active Surveillance?
Advantages:
- Avoidance of treatment side effects since no immediate treatment is administered.
- Minimal impact on daily life compared to treatment.
- Availability of curative treatments if tests show cancer progression.
Disadvantages:
- The need for repeated prostate biopsies, which can cause side effects and discomfort.
- Changes in general health could make some treatments unsuitable if cancer grows.
- Anxiety or stress about not receiving treatment and the potential for cancer progression.
- Though rare (less than 5%), there is a small chance that cancer may grow and become harder to treat.
What Does Active Surveillance Involve?
Patients on active surveillance undergo regular tests to monitor their cancer, aiming to detect any signs of growth. These tests typically include:
- PSA blood tests: Regular PSA testing is crucial as a continuous rise in PSA levels may indicate cancer growth.
- MRI scans: Initial and subsequent MRI scans help monitor the cancer's status.
- Digital rectal examinations (DRE): Doctors perform DREs to feel for changes in the prostate.
- Prostate biopsies: Additional biopsies are conducted if other tests suggest cancer progression.
How Often Will I Have Tests?
The frequency of tests can vary depending on the hospital's protocol. Typically, the schedule is as follows:
First Year of Active Surveillance:
- PSA test every three to four months.
- DRE after 12 months.
- MRI scan after 12 to 18 months.
Second Year Onwards of Active Surveillance:
- PSA test every six months.
- DRE every 12 months.
When Would I Stop Active Surveillance?
Active surveillance is discontinued if tests indicate that cancer is growing or becoming more aggressive, prompting the need for treatment aimed at curing the cancer. Patients can also choose to start treatment at any point, especially if they find it challenging to manage the anxiety of living with untreated cancer.
Is Active Surveillance Safe?
Research shows that active surveillance is a safe method for men with low-risk prostate cancer to avoid or delay unnecessary treatment. Over 90% of men on active surveillance for low-risk prostate cancer have the same survival rates at ten years as those who opt for immediate treatment.
Concerns About Not Having Prostate Cancer Treatment
While many men choose active surveillance, it isn't suitable for everyone. Some men might struggle with the idea of not receiving treatment and the potential for cancer progression. Men who experience significant anxiety or stress may opt for treatment even without signs of cancer growth.
Are There Any Side Effects?
Since active surveillance avoids immediate treatment, it also avoids the side effects of those treatments. However, prostate biopsies, which are part of the surveillance protocol, can cause short-term side effects such as infection or blood in urine, semen, or bowel movements. The risk of serious infection is higher with trans-rectal ultrasound (TRUS) biopsies than with transperineal biopsies.
How is Active Surveillance Different from Watchful Waiting?
Active surveillance and watchful waiting are often confused but serve different purposes. Active surveillance is intended for men with localised prostate cancer and involves regular testing to detect progression, with curative treatment as the goal if needed. Watchful waiting, on the other hand, is generally for men who may not tolerate curative treatments due to other health issues or age. It focuses on managing symptoms rather than aiming for a cure, involving fewer tests and usually conducted at the GP surgery.
What does a urologist think about active surveillance?
Active surveillance offers a viable option for men with low-risk prostate cancer to avoid immediate treatment and its side effects while ensuring close monitoring for any signs of cancer progression. Regular tests and monitoring provide reassurance and allow for timely intervention if necessary, making it a safe and effective approach for managing early-stage prostate cancer.
