Active Surveillance

Some men with localised (early stage) prostate cancer may not need any active treatment. The cancer will grow so slowly, if at all, that the man will live out his natural span and die of something else before the cancer causes any symptoms. Results suggest that many men on Active Surveillance will never need treatment for their prostate cancer. Unfortunately, not all early prostate cancers behave like this. Some may progress at a significant rate, so that over a period of years the cancer will grow sufficiently to cause symptoms, and may then spread to other parts of the body and become life-threatening.

Active Surveillance (sometimes called Active Monitoring) is an alternative to immediate treatment. It is now the first-line approach for men found to have low grade prostate cancer. It is a pro-active method which monitors men with early prostate cancer who do not need immediate curative treatment, so as to spare them the side effects that may be caused by a treatment that may later prove to have been unnecessary.

Men on active surveillance are closely monitored by their consultant. They would typically have an initial multi-parametric MRI scan, repeated every 1-2 years, and an annual PSA blood test..A repeat biopsy may only be needed if the MRI scan reveals any significant change. Some doctors now believe that the Free-to-Total PSA Ratio (see The PSA Test & DRE) is also an additional monitoring tool. Those cases that show signs of tumour progression will be advised to receive curative treatment, normally with surgery, radiotherapy or brachytherapy, dependent on age and other factors.

 

Advantages and disadvantages

  • Active Surveillance may avoid unnecessary treatment with its resultant side effects.
  • MRI scans now reduce any risks associated with TRUS biopsies.
  • It may also give the opportunity for a change of diet and lifestyle which may help in keeping the cancer under control.

     But:

  • It can create on-going worry about ‘having cancer’ and ‘doing nothing’.
  • It could happen that the ‘window of opportunity’ for curative treatment may be missed should the cancer unexpectedly become more aggressive.

 

A change of lifestyle?

While on Active Surveillance, you may like to consider a change of diet, taking nutritional advice from an NHS Macmillan dietitian or a trained nutritionist, or an exercise programme, as it has been shown that regular exercise can help to control the rate at which cancers develop (see Diet and Lifestyle).

Monitoring your PSA

PSA velocity (the rate at which the PSA increases) and doubling time (the period over which the PSA number doubles), together with other factors (e.g. MRIs), play an important part in any Active Surveillance programme, so it is important that you keep a careful record of your PSA results. You have the right, in co-operation with your consultant, to opt out of Active Surveillance and be treated at any stage.