Understanding that a significant number of patients with less aggressive or lower risk prostate cancer will not progress or die of their disease, active surveillance is appropriate treatment options for a certain subset of prostate cancer patients. Active surveillance involves the following key components:

  • Discussion with the patient on their risk group.
  • Continued PSA monitoring and repeat DRE on a scheduled basis over the next 12 -- 18 months after the initial biopsy that revealed prostate cancer.
  • A mandated repeat prostate biopsy and/or prostate MRI (if available) 6 -- 18 months after the initial biopsy.
  • Depending on the results of the repeat biopsy, continued monitoring and repeat biopsy(s) may be indicated.
  • If there is progression or higher Gleason grade identified on the repeat biopsy, intervention may be required.

Currently, there is no standardized protocol for active surveillance that has been approved and validated.  Thus, there is variability from practice to practice, provider to provider.  Clearly the benefit of active surveillance is avoiding treatment side effects related to intervention.  However, it must be stressed that it does not necessarily mean that the patient will never need to be treated as the tumor may progress on subsequent biopsy.  It just means that, if the patient chooses, he may not need to be treated today. 

There are times when genetic testing, may give us better insight to the true biology and aggressiveness of the tumor that is based on genomics, not on what is viewed under the microscope.  It is important to recognize that the results of either method used will yield an increase or decrease in probability in the likelihood of the presence of more aggressive cancer cells. It should be noted, however, that family history and certain histologic features clearly do warrant testing, based on the currently published guidelines.

What I know now I wish I knew before…getting checked early can save your life.

~John Sharp, prostate cancer survivor

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