Prostate Cancer (cont.)
Active Surveillance (Deferred Treatment)
Active surveillance is an appropriate management for selected patients with localized disease. This involves monitoring one's cancer to see if it gets worse and how quickly.
- Often, many PSA-detected prostate cancers are small, well differentiated, and thought to have a relatively low risk of progression. For this reason, many men will receive no active treatment or they will postpone it for some time without significantly decreasing the chance of cure.
- The goal of active surveillance is to avoid treatment-related complications for men whose cancers are not likely to progress while maintaining an opportunity for cure in those who show evidence of progression.
- Active surveillance is a conservative regimen that includes regular visits to the urologist for digital rectal exams, PSA measurements, and, if necessary, imaging tests and/or repeated prostate biopsies to assess if the cancer is becoming more aggressive over time.
- One benefit of active surveillance is that one does not experience the side effects of treatment. On the other hand, symptoms (if any) will continue. In some cases, symptoms can be at least partly relieved with medication.
- Active surveillance is most often used for men who have very early-stage cancers and for men who are not candidates for surgery and other aggressive therapies.
- If the cancer starts to grow, the urologist may recommend treatment.
- Active surveillance should be distinguished from "watchful waiting," which is based upon the premise that some men will not benefit from definitive treatment of localized prostate cancer.
- For patients managed with watchful waiting, the decision is made at the outset to forego definitive treatment and to provide palliative treatment (typically androgen-deprivation therapy) for symptomatic local or metastatic progression.
- Watchful waiting may be an acceptable alternative for elderly men or those with substantial comorbidities.
Pierre-Alain Hueber, MD, PhD
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