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Of all men diagnosed as having prostate cancer, one-third have a cancer that grows very slowly.
Treating men with slow-growing prostate cancers with surgery, radiation, or hormone therapy may not extend their life span and could lead to unwanted complications. These cancers can instead be managed using active surveillance, which means that the cancer is evaluated over time to see if it starts to grow to a point at which treatment is necessary.
What Is Active Surveillance?
Active surveillance involves having repeated blood testing for prostate-specific antigen, prostate biopsy, rectal examinations, and sometimes magnetic resonance imaging (MRI) of the prostate to monitor the size and spread of the prostate cancer. If the cancer grows or becomes more aggressive, then curative treatment with either surgery or radiation therapy is offered. Active surveillance differs from watchful waiting, in which men who have prostate cancer that is causing symptoms are treated for those symptoms without the intent of curing the prostate cancer. Watchful waiting is usually recommended for men who have a limited life expectancy.
Eligibility for Active Surveillance
Active surveillance is recommended as an option for any man with prostate cancer that is low risk and not very aggressive. It is the preferred strategy for men with the least aggressive type of prostate cancer, which is called very low-risk disease.
The risk of dying of prostate cancer is determined from prostate biopsy results, prostate-specific antigen level, whether the cancer can be felt during a rectal examination, and if imaging with x-ray, bone scan, computed tomography, or MRI suggests the cancer has spread outside of the prostate.
Considerations for Active Surveillance as a Management Choice for Prostate Cancer
After about 5 years, half of men undergoing active surveillance ultimately have curative treatment for their prostate cancer.
There is a low risk for the cancer to metastasize (spread outside the prostate) or become fatal during active surveillance. The risk of metastases during active surveillance is about 4% at 10 years and the risk of death due to prostate cancer is less than 0.5%.
Repeated prostate biopsies using ultrasound are currently the main active surveillance. Prostate biopsy can result in some discomfort. Bleeding after the biopsy in the urine, stool, or semen, though often mild, is also common. There is also a small risk (<1%) of serious infection after each prostate biopsy.
Some men experience anxiety or other psychological side effects associated with living with untreated cancer. These men may have their concerns better served with surgery or radiation.
Is Active Surveillance Right for You?
A discussion with doctors you trust about the risks and benefits of your prostate cancer management choice should ultimately guide your decision. Weighing quality-of-life priorities such as urinary continence and erectile function as well as cancer control along with other medical problems may help you make a comfortable choice.
A JAMA Patient Page on prostate cancer screening was published in the November 17, 2015, issue of JAMA. To find this and other JAMA Patient Pages, go to the For Patients collection at jamanetworkpatientpages.com.
Conflict of Interest Disclosures: All authors have completed and submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest. Dr Schaeffer reports advisory board meeting participation for Myriad Genetics and Genome Dx. No other disclosures were reported.
Sources: Siegel RL, Miller KD, Jemal A. CA Cancer J Clin. 2016;66(1):7-30.
Cooperberg MR, Carroll PR. JAMA. 2015;314(1):80-82.
Bokhorst LP, Valdagni R, Rannikko A, et al. Eur Urol. 2016;70(6):954-960.
Klotz L, Vesprini D, Sethukavalan P, et al. J Clin Oncol. 2015;33(3):272-277.
Tosoian JJ, Mamawala M, Epstein JI, et al. J Clin Oncol. 2015;33(30):3379-3385.
Matulewicz RS, Weiner AB, Schaeffer EM. Active Surveillance for Prostate Cancer. JAMA. 2017;318(21):2152. doi:10.1001/jama.2017.17222
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