By Suzana 
Active surveillance is a strategic approach to managing prostate cancer that involves closely monitoring the disease rather than opting for immediate aggressive treatment. This method is often chosen for patients with low-risk prostate cancer, where the cancer is detected early and shows slow progression. The aim is to avoid or delay treatments that can have significant side effects, such as surgery or radiation, and instead, focus on regular monitoring to ensure the cancer remains manageable.
Criteria for Active Surveillance
Not all prostate cancer cases are suited for active surveillance. Typically, this approach is recommended for patients with low-risk prostate cancer, characterized by a low Gleason score (a measure of cancer aggressiveness), a low PSA level (prostate-specific antigen), and a small tumor volume. Additionally, patients should be in good overall health and able to adhere to the follow-up schedule required for effective monitoring.
Before starting active surveillance, a thorough evaluation is performed to confirm that the cancer is indeed low-risk. This includes a biopsy, imaging tests, and sometimes a second opinion to ensure that the cancer’s characteristics align with the criteria for active surveillance. The decision is made collaboratively by the patient and their healthcare team, considering all relevant factors.
Monitoring Techniques
Active surveillance involves a rigorous schedule of monitoring to track the cancer’s progression. This typically includes regular PSA tests, digital rectal exams (DRE), and periodic biopsies. PSA tests measure the levels of prostate-specific antigen in the blood, which can indicate changes in the cancer’s behavior. Digital rectal exams allow the doctor to physically assess the prostate for any changes in size or texture.
Biopsies are performed at intervals to evaluate whether the cancer is growing or changing. These biopsies help determine if the initial assessment of the cancer’s risk remains accurate or if a change in treatment strategy is needed. Some patients may also undergo imaging tests such as MRI or PET scans to provide additional information about the cancer’s status.
Benefits of Active Surveillance
One of the primary benefits of active surveillance is the avoidance of immediate, potentially invasive treatments. For many patients with low-risk prostate cancer, aggressive treatments can lead to significant side effects, including urinary incontinence, erectile dysfunction, and bowel problems. By opting for active surveillance, patients can maintain their quality of life while still effectively managing their cancer.
Active surveillance also allows for a more personalized approach to treatment. Since prostate cancer often grows slowly, the monitoring process provides time to better understand the disease and adjust the treatment plan as necessary. If signs of progression are detected, treatments can be introduced at a stage when they may be more effective and less disruptive.
Potential Risks and Challenges
While active surveillance offers many advantages, it is not without its risks and challenges. The primary risk is the potential for the cancer to progress unnoticed. Despite regular monitoring, there is a possibility that the cancer may become more aggressive or spread beyond the prostate. This could lead to a situation where the cancer is more difficult to treat or requires more intensive intervention.
Another challenge is the psychological impact of living with a cancer diagnosis and the uncertainty associated with ongoing surveillance. Some patients may experience anxiety or stress about the potential for disease progression. Open communication with healthcare providers, support from mental health professionals, and joining support groups can help manage these concerns.
Making the Decision
Choosing active surveillance requires a careful assessment of the individual’s cancer characteristics, overall health, and personal preferences. The decision is usually made after discussing the potential benefits and risks with a healthcare team, which may include urologists, oncologists, and other specialists. It’s important for patients to fully understand their diagnosis, the surveillance process, and how to manage any potential changes in their condition.
Active surveillance is not a static process; it involves ongoing engagement with healthcare providers and regular evaluations. Patients must be proactive about attending follow-up appointments and adhering to the monitoring schedule to ensure that any changes in the cancer’s behavior are detected early.
Adjusting the Approach
If monitoring reveals that the cancer is no longer low-risk or shows signs of progression, the treatment plan may need to be adjusted. This could involve transitioning to more active treatment options such as surgery, radiation therapy, or hormone therapy. The flexibility of active surveillance allows for a tailored approach, where treatment can be introduced at the most appropriate time based on the cancer’s development and the patient’s condition.
The goal of active surveillance is to balance effective cancer management with maintaining a good quality of life. By carefully monitoring prostate cancer and intervening when necessary, patients can avoid unnecessary treatments and focus on their overall well-being while managing their cancer effectively.