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Active Surveillance

What is Active Surveillance?

The concept of Active Surveillance has increasingly emerged as a viable option for men who decide not to undergo immediate radical treatment for prostate cancer (surgery or radiation therapy).

Active Surveillance is based on the concept that low-risk prostate cancer is unlikely to harm you or decrease your life expectancy. Over 30% of men have prostate cancers that are so slow growing and “lazy” that Active Surveillance is a better choice than immediate local treatment with surgery or radiation. Of the top 10 most common cancers, prostate cancer is the only one in which so many patients have a slow-growing tumor that does not warrant aggressive immediate treatment.

Active Surveillance is not “no treatment,” but rather a strategy to treat you only if and when your cancer warrants treatment (some think of it as deferred treatment only if you need it).

It can feel counterintuitive to be told that you have cancer, but that the best option is to sit and wait. But studies show that men with low-risk prostate cancer who have been on Active Surveillance for 10 to 15 years after diagnosis have remarkably low rates of their disease spreading or dying of prostate cancer. In fact, a Johns Hopkins study of men on Active Surveillance found that, 15 years later, less than 1% of men developed metastatic disease. This is important because treatments used for localized prostate cancer—surgery and radiation—have side effects that can alter a person’s quality of life.

The key to these successful numbers is making sure you are monitored regularly for signs of progression. A PSA blood test and digital rectal exam (DRE) are usually done once or twice per year by your urologist, with a repeat biopsy of the prostate every 1 to 5 years. If there is evidence that the cancer is progressing, treatment may be warranted.

Who should choose Active Surveillance?

Some of the characteristics that might qualify you for Active Surveillance include grade group 1 or Gleason 6, a PSA level <10, cancer that is confined to the prostate, and/or cancer that is very low volume when biopsied.

The ideal candidate for Active Surveillance has low-risk prostate cancer. Learn more about Risk Groups.

Does my age influence whether Active Surveillance is the right choice for me?

Younger men will live longer with their cancers, and thus have a higher likelihood that their cancer could progress. However, younger men whose cancers appear to be less aggressive may be able to stay on Active Surveillance longer. Younger men also have more to lose when it comes to quality of life as they often have better erectile and urinary function than older men.

Active Surveillance may also be more appropriate for men who are currently battling other serious disorders or diseases—such as significant heart disease, long- standing high blood pressure, or poorly controlled diabetes. In a patient with other health issues, the patient and his doctors might feel that performing invasive tests or treatment would cause more harm than benefit. For these men, their treatment plan would of course help manage any symptoms that occur due to advanced disease. There are also some men with favorable intermediate risk who may be good candidates for Active Surveillance.

Some physicians also administer commercial biomarker tests of biopsy tissue—such as Decipher®, Oncotype DX Prostate®, and Prolaris®—that may be helpful in determining if you are a good candidate for Active Surveillance. Researchers are working to define the best ways to use these tests.

Active Surveillance is only a good choice for men whose lives are expected to be long enough to benefit from curative therapy should the cancer become more aggressive over time. For older men who have a limited life expectancy, watchful waiting may be more appropriate. Watchful waiting is a more conservative approach without the intent to cure, in which the goal of treatment is simply to manage symptoms as they arise.

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