Active surveillance: where are we now?


By Kalli Spencer

Active surveillance (AS) is an approach that uses a combination of PSA testing, prostate examinations, and prostate biopsies to monitor prostate cancer. Traditionally its has been advocated for those with localised very low risk and low risk stages of disease, but more recently has included favourable-intermediate risk low volume disease as well. The risk group stratification is determined by what the urologist can feel during a prostate exam, the PSA level and what grade group the patient is designated by the pathologist based on the prostate biopsy results. The benefit of active surveillance is that it avoids radical therapies such as radiation and radical prostatectomies thereby avoiding some of the side effects of those treatments that may hamper quality of life, such as erectile dysfunction and urinary incontinence. This blog will highlight some of the current research findings as presented in a recent review article published this year.

The article reviews 13 different studies from various parts of the world including Australia. The average age range was between 62-68 years, with studies containing over 5000 participants and follow-up periods of up to 10 years. The inclusion criteria for each of the studies varied. PSA levels of up to 20 were acceptable in some studies, the urologist may feel cancer in both lobes of the prostate (clinical stage: T2C) and the pathology report Grade Group 2 was the maximum. Some studies also used 2-3 positive prostate biopsy cores as a limit or the percentage positive cores up to 50%.

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