All About Active Surveillance for Prostate Cancer

Cancer is one of those words that makes people automatically fear the unknown. Questions flood the mind - is there a cure for it? Can I beat it? What are my options? It’s natural for anyone who receives a cancer diagnosis to wonder what comes next. But with prostate cancer, a disease that impacts nearly 250,000 American men each year, the answer may surprise you.

“Active surveillance” is one of the most commonly prescribed forms for monitoring prostate cancer, and it’s also one of the least aggressive forms, paling in comparison to modalities like surgery or chemo. 

We know that the various prostate cancer stages will dictate how health care providers proceed with treatment, but for a lot of newly diagnosed men, active surveillance is an appropriate and effective route to take. On the heels of a new study that found active surveillance for prostate cancer is generally safe, we wanted to explore the topic further in today’s blog post.

What is active surveillance?

According to the Prostate Cancer Foundation, “active surveillance is based on the concept that low-risk prostate cancer is unlikely to harm you or decrease your life expectancy.” This shouldn’t come as a surprise since prostate cancer’s five-year relative survival rate is nearly 100% for localized and regional forms of the disease. But it’s the reason why the low-risk prostate cancer survival rate is so good that makes active surveillance a potentially good path to follow.

More than 30% of patients have prostate cancer considered “slow growing” and “lazy.” That means that in many cases, monitoring how (or if) the cancer evolves is in the best interest of the patient. In doing so, patients can often avoid (or at least delay) experiencing side effects of more harsh treatments that may include incontinence and erectile dysfunction.

It’s important to note that any treatment method, including active surveillance, should come from your doctor. Always consult with your care team for their advice on how best to move forward.

How active surveillance works

The important thing to remember is that active surveillance doesn’t mean inaction—in fact, many would argue that the demonstrable steps taken during active surveillance go a long way toward improving the patient’s chances of beating the disease. Active surveillance involves regular doctor visits that enable the cancer care team to adequately track the cancer’s progression while the risk is minimal and the patient’s prostate cancer survival rate remains high. 

The American Society of Clinical Oncology has specific periodic evaluation guidelines for patients undergoing active surveillance for prostate cancer. Those recommendations include a prostate-specific antigen (PSA) test at least every three to six months, an annual digital rectal exam and at least one prostate biopsy every two to five years. If the results of those procedures show abnormal findings or new growth, more aggressive treatment is likely to be recommended.

However, recent research has indicated that MRI is a more cost-effective method of monitoring during active surveillance than repeat biopsies and PSA tests––and it seems to be more effective too. According to NYU Langone Health, “The study also determined men with low-risk prostate cancer who incorporate MRI during active surveillance had a higher life expectancy, and preserved quality of life.”

Dr. Mark Emberton with the University College London has overseen multiple landmark trials that uncovered similar results. According to Dr. Emberton, MRI scans result in fewer unnecessary invasive biopsies for men. “MRI for all men prior to biopsy of the prostate is the most important development in the management of men with early prostate cancer that we have had in the last 100 years,” he said.

Who is a good candidate for active surveillance?

You should know that prostate cancer stages range from one through four, with letters used to delineate differences within each individual stage. The lower the number and letter, the more localized and less aggressive the cancer. The ideal candidate for active surveillance is someone designated with a less advanced stage, where the cancer has not spread and is not expected to rapidly grow. Additionally, Johns Hopkins Medicine lists a few other qualifications in describing top candidates for active surveillance, including a lack of symptoms and a long life expectancy.

Research on active surveillance           

The study we cited earlier is far from the only peer-reviewed research to tout the merits of active surveillance. Data and outcomes from multiple cohorts involved in active surveillance research consistently showed a “low rate of progression to metastatic disease or death from prostate cancer.” Other trials showing prostate cancer patients who required more intensive intervention years after the start of their active surveillance were still shown to have “favorable pathologic tumor features.”

Promaxo‘s role in prostate health
Promaxo offers urologists and patients the ability to track and monitor disease progression, but we can do much more than just assist with active surveillance. Our technology can be used to guide targeted interventions so that when a prostate biopsy ultimately proves to be cancerous it can then be treated in a more targeted manner. 

We all hope to one day live in a world that’s cancer-free, but for now, we’re for anything that’s patient-friendly and patient-focused.