Active surveillance for prostate cancer is done more than ever now. Sometimes it is strange for a patient to hear that the best thing to do is to monitor the cancer because they are so used to the idea that cancers need to be treated as soon as they are discovered. Men on active surveillance are monitored with periodic biopsies, physical exams of the prostate and prostate-specific antigen (PSA) tests. Treatment begins only when the cancer shows signs of progression. But is it safe to wait until then? More and more studies add growing evidence that the answer is yes, but only for men whose cancers fall into favorable risk categories.
Today, the man who is ideal for active surveillance has a low risk prostate cancer (Gleason score <6, PSA <10, favorable genetic testing). Additional factors that are often considered favorable are a low volume of cancer (small amount of cancer found on biopsy, for example).
T1c tumors cannot be felt during DRE; they’re usually discovered after a rising PSA prompts a biopsy. T2a tumors can be felt, but they are confined to the prostate and less than half of one of the gland’s lobes.
For men with a life expectancy greater than 15 years, the cancer should be in only one or two cores and constitute less than half of those cores.
Patients who meet these criteria can still opt for traditional treatments. For example, some find the psychological burden of living with cancer too great. One’s age, family history, and other medical conditions can also sway decision-making.
Active surveillance might also be a good choice for older men who have a limited life expectancy. In addition, if a man is currently battling other serious disorders or diseases, such as heart disease, long-standing high blood pressure, or poorly controlled diabetes, it may be in his best interest to hold off on immediate therapy and avoid its potential complications. Active surveillance is not for every patient but is a reasonable alternative in carefully selected patients who do not want to take the risks associated with treatments.