Active surveillance
With very small, non-aggressive cancers, the likelihood that the cancer will progress is relatively low. As long as this type of cancer doesn’t change, the patient is very likely to die with, rather than from prostate cancer.
In this case, to avoid the risk of overtreatment, an active surveillance approach has been developed. Patients meeting the following criteria are likely to be considered for this approach:
- clinical stage cT1 or cT2a (i.e. small tumour size)
- a prostate biopsy obtains a maximum of 2 samples containing cancer cells (i.e. small tumour size)
- PSA < 10 ng/ml
- Gleason score ≤ 6
Where an active surveillance approach is taken, the patient’s PSA level will be measured and a digital rectal examination performed every 3 months for the first two years.
Regular biopsies will also be required, initially every 6–12 months, then every 18 months. If the cancer remains stable, the interval between biopsies can then be extended to every 3 years.
If follow-up tests or biopsies find an increase in PSA levels or in the Gleason score, it will usually be appropriate to stop active surveillance.
The objective of active surveillance is only to actively treat prostate cancer if it becomes likely that it will progress and cause lasting harm to the patient if left untreated.
