Active Surveillance for Prostate Cancer
Active surveillance (expectant management) for men with prostate cancer is the postponement of immediate therapy, with definitive treatment (such as brachytherapy, external beam radiation or surgery) if there is no evidence that the patient is at increased risk for disease progression. Active surveillance is an accepted option for the initial management of carefully selected men with localized, well-differentiated prostate cancer thought to be at low-risk for progression. This means that men undergo periodic evaluations including PSA tests, digital rectal examinations (DRE), and prostate biopsies. If there is evidence that the cancer is growing, treatment is recommended with the intention of curing the disease. With appropriate surveillance, patients can be reclassified as being at higher risk for disease progression and receive definitive therapy without substantially decreasing the chance of cure.
Who are the best candidates for Active Surveillance?
- Men who have the ability to live with cancer without worry reducing their quality of life
- Men who are willing to commit to the serial exams, PSA’s and biopsies
- Men who are most concerned about the potential side effects of treatments
- Men who value near term quality of life to a greater extent than any long term consequences that could occur
Each man should carefully weigh the potential loss of quality of life with treatment (radiation or surgery), against the possibility that the disease may progress requiring more aggressive therapy.
CPCC Active Surveillance guidelines:
- Stereotactic Transperineal Prostate Mapping Biopsy to ensure comprehensive results
- Gleason score 3+3=6 or 3+4=7 (if very low percentage of biopsy specimens)
- PSA less than 10 ng/ml
- No more than 2 positive cores or cancer involving no more than 50% of any core
- Prolaris score to measure the aggressiveness of the cancer
- PSA every 6 months
- DRE every 3 months
- Stereotactic Transperineal Prostate Mapping Biopsy every 2 years
“I was very pleased with Chicago Prostate Cancer Center and its non-institutional atmosphere. It has a very pleasing and healing effect. The nurses and staff make a person feel very welcome and comfortable.”
— Barry C. – Chicago, Illinois