Active Surveillance For Prostate Cancer

Prostate cancer affects many men, but not all cases require immediate treatment. For some, the cancer grows slowly and may never pose a serious health risk. Active surveillance offers a carefully managed approach, combining regular monitoring with advanced diagnostic tools. This strategy allows patients to potentially avoid unnecessary treatments while staying vigilant about their health. If the cancer shows signs of progression, more definitive treatment options can be explored.

Prostate cancer: what you need to know

Prostate cancer originates in the prostate gland, an integral component of the male reproductive system. While the precise causes remain elusive, several factors may elevate your risk:

• Age: Risk increases significantly after 50
• Family history: Close relatives with prostate cancer may indicate higher susceptibility
• Racial background: African American men face elevated risk

Early-stage prostate cancer often presents without noticeable symptoms. As the disease progresses, potential signs include urinary difficulties, blood in urine or semen, or pelvic discomfort. Regular screenings, such as PSA tests and digital rectal exams, are invaluable for early detection.

Your healthcare team assesses prostate cancer using multiple metrics:

• Tumor Staging (I to IV): Measures the extent of cancer spread
• Gleason Score (6 to 10): Evaluates cancer aggressiveness at the microscopic level
• Cambridge Prognostic Group System: Integrates stage, grade, and PSA level for risk categorization

These factors provide a comprehensive picture of your prostate cancer, facilitating informed decision-making about your care. For most low-risk and some intermediate-risk men, active surveillance is becoming the preferred management strategy. 

What is Active Surveillance?

Active surveillance is a precise monitoring approach for men with low-risk prostate cancer. This strategy involves regular check-ups and tests to track your cancer without immediate treatment. The aim is to avoid unnecessary interventions while promptly detecting any significant changes. Your healthcare team will conduct:

• Regular PSA tests
• Periodic digital rectal exams
• Intermittent prostate biopsies as needed

This approach allows you to potentially avoid treatment side effects while maintaining vigilant oversight of your health.

Why is Active Surveillance done?

Active surveillance balances the management of low-risk prostate cancer with maintaining your quality of life. Many prostate cancers grow slowly and may never threaten your health. By choosing active surveillance, you can:

• Avoid or delay potential treatment side effects
• Maintain your current lifestyle and activities
• Preserve the option for treatment if necessary

The principle behind active surveillance is to provide care that offers the most benefit with the least risk, aligning with best practices in medical care.

Who should choose Active Surveillance?

Active surveillance is typically recommended for men with specific low-risk prostate cancer characteristics:

• Gleason score of 6 or less
• Cancer confined to a small area of the prostate

For men with more aggressive prostate cancer, other treatments like surgery, radiation, or ADT (Androgen Deprivation Therapy) for prostate cancer may be more appropriate. Each case is different at the end of the day. Your healthcare provider will consider your overall health and ability to commit to regular follow-ups when recommending this approach. Together, you’ll make an informed decision based on your individual circumstances and preferences.

Does age influence whether Active Surveillance is the right option?

Age is an important consideration in the active surveillance decision, but it’s not the only determining factor. Older men, particularly those over 70, often benefit more from this approach. Their cancer is less likely to progress to a life-threatening stage before other health issues become more pressing. Younger men might lean towards treatment due to their longer life expectancy.

Several factors influence this decision:

• Overall health status
• Cancer characteristics
• Personal preferences and values
• Ability to adhere to follow-up schedules

Your healthcare team will help you evaluate these factors to determine the most appropriate path for your individual situation. 

The advantages & disadvantages of Active Surveillance

Advantages of Active Surveillance:

• Avoid or delay treatment side effects including erectile dysfunction (chronic inability to achieve or maintain an erection satisfactory for sexual intercourse) and urinary incontinence (partial or complete loss of bladder control)
• Less impact on quality of life/normal activities
• Less risk of unnecessary treatment of small, slow-growing cancers

Disadvantages of Active Surveillance:

• Low chance of missed opportunity for cure
• Periodic follow-up MRI and/or prostate biopsies may be necessary

Comparing Active Surveillance to Other Treatment Options

When comparing active surveillance to other treatment options like surgery or radiation therapy, several factors come into play. Active surveillance avoids immediate side effects but carries the risk of cancer progression. Surgery and radiation offer potential cures but come with significant side effects. Watchful waiting, another observation strategy, is less intensive than active surveillance and typically used for older men or those with other health issues. Hormone therapy might be considered for more advanced cases. The choice between these options depends on the individual’s cancer characteristics, overall health, and personal preferences.

What you can expect to happen during Active Surveillance

According to prostate cancer treatment guidelines you doctor may suggest the following:

• PSA (blood test) > every 3-6 months unless clinically indicated
• DRE (digital rectal exam) no more often than every 12 months unless clinically indicated
• Repeat prostate biopsy no more often than every 6-12 months unless clinically indicated
• MRI Imaging of the prostate may be recommended

Myriad Genetics’ Prolaris test provides new information about your cancer than no other test can. The Prolaris test can determine just how unique and aggressive your prostate cancer truly is. Your Prolaris Score provides individualized information about your specific cancer to help you and your physician develop the appropriate treatment plan.

The future of prostate cancer Active Surveillance

Medical science continues to advance our approach to prostate cancer management. Active surveillance is evolving, incorporating new technologies to enhance patient care and improve decision-making processes.

Genomic testing: a new frontier in risk assessment

Genetic testing for prostate cancer is revolutionizing active surveillance strategies.  These advanced tests, like the Prolaris test, look at the genetic makeup of cancer cells. This approach provides valuable insights into how a tumor might behave and potentially progress. Prolaris specifically assesses the 10-year risk of cancer-related mortality without treatment and the risk of cancer spread after treatment. Notably, Prolaris is the only test with a twice-validated active surveillance threshold, offering high confidence in its results for guiding treatment decisions.

Here’s what Prolaris offers:

• Combines genetic information with clinical factors for comprehensive analysis
• Delivers personalized risk assessment for each patient

Helps answer critical patient questions such as:

• Is active surveillance appropriate, or is treatment needed?
• What’s the risk of cancer spread?
• What are my survival chances?
• Should I add hormone therapy (ADT) to radiation?
• Guides treatment decisions, balancing aggressive and conservative approaches

Genomic tests assess the aggressiveness and growth rate of tumors, providing a more detailed risk assessment than traditional methods alone. This critical information helps doctors determine who can safely undergo active surveillance and who requires immediate treatment, leading to more confident decision-making for both patients and healthcare providers.

Technological advancements in monitoring

New technologies are changing how we monitor prostate cancer:

1. Liquid biopsies: These are blood tests that can detect cancer cells or DNA. They may offer a less invasive alternative to traditional prostate biopsies and could provide up-to-date information about cancer status during active surveillance.
2. Wearable devices and apps: These tools can help patients keep track of their symptoms, medication use, and overall well-being. They can also improve communication between patients and their healthcare providers.

These advancements aim to improve the active surveillance experience. They provide more accurate and timely information to both patients and healthcare providers. As our understanding of prostate cancer grows, tools like Prolaris test and these new technologies offer the potential for more personalized and effective care strategies.