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Active Surveillance Used More to Monitor Prostate Cancer

May 02, 2023

Prostate cancer may not always be as sinister as the word “cancer” implies.

Eric Katz, MD, an endourology and minimally invasive surgery specialist with Hartford HealthCare’s Tallwood Urology & Kidney Institute, says the most important thing for someone newly diagnosed with prostate cancer to know is the disease is not one-size-fits-all.

“Rather, it’s on a wide spectrum, ranging from very low risk to very high risk or very aggressive, and there is a lot of gray area in between,” he says.

For patients with certain low-risk types, experts often recommend management called active surveillance to determine who ultimately needs treatment and who can safely avoid it. As they learn more about prostate cancer’s natural history, the approach is used more. An analysis shows a 44% increase in active surveillance for patients with low-risk prostate cancer from 2010 to 2018.

Watching for signs

Active surveillance involves closely monitoring the cancer through routine testing, including:

• Physical exams
• Prostate-specific antigen (PSA) blood tests
• Prostate biopsies
• MRIs

“If, at some point, we find a patient has a more concerning form of prostate cancer, we intervene with definitive treatment to maintain the goal of cure,” Dr. Katz says, noting 30-50% of patients on active surveillance eventually undergo treatment within 10 years of diagnosis.

By delaying or avoiding treatment, Dr. Katz says men can maintain their quality of life and wellbeing instead of undergoing radical treatment with its potential side effects.

“This is not a case of ignoring the cancer or decisively saying these patients do not need treatment. Rather, we use this strategy to monitor them closely to determine who needs treatment,” Dr. Katz says.

Is it safe?

Over the past few years, research has underscored the safety of active surveillance for low-risk prostate cancer.

“Studies demonstrated that low-risk prostate cancer – based on exam, PSA and biopsy results – is very slow growing and unlikely to spread,” Dr. Katz adds. “In the trials, patients with low-risk disease were followed for 10-20 years, and there was minimal benefit when they were treated with surgery or radiation rather than followed closely with active surveillance.

“Treatment, ultimately, had no impact on the chance of dying from prostate cancer.”

In addition, there is less than 1% risk of missing the chance for cure and developing more advanced disease during that time, he adds. Even so, patients are often reluctant to skip immediate treatment.

“Some have doubts and think we are ignoring their prostate cancer. But, when they understand we are keeping a very close eye on it, and plan to intervene if we detect anything more concerning, it often eases their concerns,” he says.