The prognosis of prostate cancer has changed dramatically over the past few decades.
Recent advances in cancer detection and prostate specific antigen (PSA) screening have diminished the relative incidence of high volume and aggressive tumours, with a stage shift to lower volume, lower grade tumours. The widespread use of PSA has been associated with a substantial decline in prostate cancer mortality. Many low grade cancers are unlikely to progress to clinical symptoms, and pose limited risk of death if left untreated. The long term safety of active surveillance depends on the clinician's ability to initiate timely delayed intervention in those who need it, and to avoid overtreatment in those who do not. A range of variables associated with disease progression have been proposed as triggers to proceed with delayed curative therapy.
BACKGROUND: Active surveillance, followed by delayed definitive treatment for those who develop evidence of significant cancer progression, is now a recognised management strategy for selected men with low risk prostate cancer.
OBJECTIVE: This article summarises the role of active surveillance in the management of prostate cancer. It outlines the benefits of active surveillance and the indications for proceeding with curative treatments if required.
DISCUSSION: A considerable proportion of men with low grade prostate cancer on biopsy may never progress to higher stage disease or develop symptoms from their cancers. These patients are suitable for active surveillance under the care of a urologist. Active surveillance involves initial stringent observation of the prostate cancer, with inclusion of monitoring biopsies rather than immediate active treatment in the form of surgery or radiotherapy. With careful selection, about 70% of men will not require any intervention for at least 5 years. Men with low grade disease should be offered active surveillance as a treatment option and provided with information about the risks and benefits of this approach.
Written by:
Yaxley J, Yaxley J, Gardiner R, Yaxley W. Are you the author?
Griffith University, Gold Coast, Queensland.
Reference: Aust Fam Physician. 2013 Jan-Feb;42(1-2):74-6.
PubMed Abstract
PMID: 23529468
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