Active surveillance is a good strategy for men with clinically insignificant prostate cancer who want to preserve their erectile and urinary function until definitive treatment is needed
The author of this paper has pioneered a treatment strategy for low risk prostate cancer called active surveillance. This is for men who do not want immediate treatment in order to preserve some years of good quality of life especially erectile and urinary function, until such a time that during the monitoring of their cancer it becomes necessary to offer definitive treatment. This is based on population data telling us that men with insignificant cancers are more likely to die from other causes. The best candidates are men who fulfill the Epstein criteria for insignificant cancer and are under 60-65 and only have Gleason 3+3:
- No more than 1/3 of biopsy cores positive
- No more than 50% of any core involved
- PSA density < 0.15 where PSA density is PSA level ng/mL divided by prostate volume.
The benefits are better quality of life including preserved erections and normal urinary and bowel function. The problems are anxiety and psychological impact of living with a known cancer and that the cancer may progress to an advanced stage while on the active surveillance program. It is imperative that education and reassurance is given to patient and the follow up schedule be closely adhered to:
- PSA and rectal exam every 3 months for 2 years
- 12 core biopsy within year 1
- repeat biopsy every 2-5 years depending
- Optimal is MRI scan at baseline for borderline PSA kinetics or pathology
Intervention is offered if:
- PSADT is less than 3 years based on 8 at least 8 measurements
- Progression in terms of Epstein criteria or grade progression to 3+4.