Is active surveillance considered treatment?
Active surveillance is a form of treatment. It's not the same as receiving no treatment at all. With this method, we put off treatments, such as surgery and radiation therapy, because tests indicate that the tumor is currently not life threatening or is at a low risk of spreading or getting worse.
When do you stop active surveillance for prostate cancer?
Active Surveillance (AS) has emerged as a way to mitigate this problem, by delaying treatment of men, who are at low-risk until this becomes necessary. However, it is not known after how much time or biopsy rounds should patients stop AS and transition to conservative management (CM), if no progression is detected.
When do you use active surveillance?
Active surveillance may be used to avoid or delay the need for treatments such as radiation therapy or surgery, which can cause side effects or other problems. During active surveillance, certain exams and tests are done on a regular schedule.
What is the difference between active surveillance and watchful waiting in prostate cancer?
Action is taken only if the cancer changes or grows. Active surveillance may require you to have many biopsies to track cancer growth. Watchful waiting is a less aggressive system of monitoring prostate cancer without treating it. It does not involve regular biopsies or other frequent testing.
Should Gleason 6 Be Treated?
Since the Gleason 6 lacks the hallmarks of a cancer, it is a pseudocancer, not a health risk; does not progress to become a health risk; needs no detection; and needs no treatment.
Should Gleason 3/4 Be Treated?
Current American Society of Clinical Oncology (ASCO)/Cancer Care Ontario (CCO) guidelines recommend treatment for most men with intermediate-risk disease, but state that men with low-volume Gleason 3+4 prostate cancer may be considered for active surveillance.
What are the 5 steps of surveillance?
Major SectionsSection 1: Introduction.Section 2: Purpose and Characteristics of Public Health Surveillance.Section 3: Identifying Health Problems for Surveillance.Section 4: Identifying or Collecting Data for Surveillance.Section 5: Analyzing and Interpreting Data.Section 6: Disseminating Data and Interpretations.More items...
Who qualifies for active surveillance?
Some of the characteristics that might qualify you for Active Surveillance include grade group 1 or Gleason 6, a PSA level <10, cancer that is confined to the prostate, and/or cancer that is very low volume when biopsied. The ideal candidate for Active Surveillance has low-risk prostate cancer.
What are the 3 types of surveillance?
Different surveillance methodsElectronic surveillance – Electronic surveillance equipment is often the most used tool during an investigation. ... Interviews – Interviews are far less common, but they can serve a purpose in certain investigations. ... Observation – You can gather a lot of information just by observing someone.More items...•
What is the difference between passive surveillance and active surveillance?
Definitions and Basic Concepts Active surveillance provides the most accurate and timely information, but it is also expensive. Passive surveillance: a system by which a health jurisdiction receives reports submitted from hospitals, clinics, public health units, or other sources.
Why would a physician recommend watch and wait for prostate cancer?
Avoid Side Effects of Treatment and Testing Similar to active surveillance, patients under watchful waiting may choose to delay treatment because of its associated risks and side effects. With watchful waiting, men with compromised health can also avoid the side effects associated with repeated tests and biopsies.
What is the most important use of active surveillance?
Active surveillance is often used to mean monitoring the cancer closely. Usually this includes a doctor visit with a prostate-specific antigen (PSA) blood test about every 6 months and a digital rectal exam (DRE) at least once a year. Prostate biopsies and imaging tests may be done every 1 to 3 years as well.
Why is active surveillance important?
Active surveillance may be an option if the cancer is slow growing, if treatment may have more side effects than the cancer itself and where delaying treatment is unlikely to cause harm.
Can you cure cancer with radiation?
In other words, if a person is only expected to live another 10 years and has a very low-risk cancer, we can cure him or her with radiation or surgery, but there are a number of side effects from treatment that could be avoided if we use active surveillance instead.
What is active surveillance?
The concept of Active Surveillance has increasingly emerged as a viable option for men who decide not to undergo immediate radical treatment for prostate cancer ( surgery or radiation therapy ). Active Surveillance is based on the concept that low-risk prostate cancer is unlikely to harm you or decrease your life expectancy.
What tests are used for active surveillance?
Some physicians also administer commercial genetic tests—such as Decipher®, ProMark®, and Prolaris®—that may be helpful in determining if you are a good candidate for Active Surveillance.
How long do men with prostate cancer stay on active surveillance?
But studies show that men with low-risk prostate cancer who have been on Active Surveillance for 10 to 15 years after diagnosis have remarkably low rates of their disease spreading or dying of prostate cancer.
Why is it important to monitor prostate cancer?
This is important because treatments used for localized prostate cancer—surgery and radiation—have side effects that can alter a person’s quality of life. The key to these successful numbers is making sure you are monitored regularly for signs of progression.
Is active surveillance a treatment?
Active Surveillance is not “no treatment,” but rather a strategy to treat you only if and when your cancer warrants treatment (some think of it as deferred treatment only if you need it). It can feel counterintuitive to be told that you have cancer, but that the best option is to sit and wait.
Is watchful waiting appropriate for older men?
For older men who have a limited life expectancy, watchful waiting may be more appropriate. Watchful waiting is a more conservative approach without the intent to cure, in which the goal of treatment is simply to manage symptoms as they arise. Overview. Radiation.
Can invasive tests cause more harm than benefit?
In a patient with other health issues, the patient and his doctors might feel that performing invasive tests or treatment would cause more harm than benefit. For these men, their treatment plan would of course help manage any symptoms that occur due to advanced disease.
Feeling the prostate
During a digital rectal exam (DRE), the doctor inserts a lubricated, gloved finger into the rectum. Because the prostate sits in front of the rectum, the doctor can feel part of it through the rectal wall. A normal prostate is small — about an inch and a half from side to side — and feels smooth and rubbery.
Figure 1: Zones of the prostate
When doctors talk about parts of the prostate, they may refer to the apex, located at the bottom of the prostate; the base, counterintuitively at the top; and the mid-zone, the space between the apex and the base.
No rush
Boorjian SA, Bianco FJ, Scardino PT, Eastham JA. Does the Time from Biopsy to Surgery Affect Biochemical Recurrence After Radical Prostatectomy? BJU International 2005;96:773–76. PMID: 16153197.
Common side effects
Sexual side effects, urinary incontinence, and bowel problems occur to varying degrees with all prostate cancer treatments. A recent Harvard study polled 1,201 patients about side effects and quality of life following prostatectomy, external beam radiation, and brachytherapy.
Surgery vs. watchful waiting
Bill-Axelson A, Holmberg L, Filén F, et al. Radical Prostatectomy Versus Watchful Waiting in Localized Prostate Cancer: The Scandinavian Prostate Cancer Group-4 Randomized Trial. Journal of the National Cancer Institute 2008;1144–54. PMID: 18695132.
Suggested criteria for active surveillance
Researchers at the University of Toronto developed a treatment algorithm to better differentiate men with prostate cancer who can pursue active surveillance from those who need more immediate treatment. Those considered eligible for active surveillance have
Guidelines for intervention
The same Toronto researchers who established active surveillance criteria recommend suspending active surveillance if one of the following happens:
What the studies say
Clinical studies have been mixed about the health outcomes of men with early prostate cancer who adopt a strategy of active surveillance, as compared with men who choose other strategies. Unfortunately, this only further muddies the waters and makes it hard to provide clear guidelines for treatment.
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Benefits and risks of active surveillance
The chief benefit of active surveillance is that it allows you to avoid the possible side effects of treatment for early-stage prostate cancer. Some men also welcome the opportunity to buy time, as they wait for improved methods of detection or new treatment options.
Disclaimer
As a service to our readers, Harvard Health Publishing provides access to our library of archived content. Please note the date of last review or update on all articles. No content on this site, regardless of date, should ever be used as a substitute for direct medical advice from your doctor or other qualified clinician.
What is active surveillance for prostate cancer?
Active Surveillance for Prostate Cancer. If diagnosed with localized prostate cancer (cancer that has not spread to distant sites such as bones and lymph nodes), disease management can take many forms, depending on the risk category of disease.
What is the Gleason score for cancer?
It may also be an option for patients with a Gleason score of 7.
Is active surveillance safe?
How to Make Active Surveillance Safer. For carefully screened patients , active surveillance can prevent the unnecessary treatment of prostate cancer. However, this approach is not without potential side effects.
Can you live with cancer without worry?
Your tumor is small and is expected to grow slowly. You aren’t experiencing any symptoms. You have the ability to live with cancer without worry reducing your quality of life. You value near-term quality of life to a greater extent than any long-term consequences that could occur.
Can prostate cancer be monitored?
Patients with low-grade, slow-growing tumors confined to the prostate gland may consider active surveillance. This involves monitoring prostate cancer in its localized stage until your doctor feels that further treatment is needed to halt the disease at a curable stage.
How long can a man with prostate cancer stay on active surveillance?
Gregg cites long-term studies that show many men with low-risk prostate cancer can remain on active surveillance for a number of years without requiring treatment, while many ultimately do not end up getting treated all.
What are the options for prostate cancer?
Treatment options typically are surgery to remove the prostate or radiation therapy. You may also get hormone therapy along with radiation therapy.
Is prostate cancer a surveillance?
If you have intermediate- or high-risk prostate cancer, surveillance may not be the best option, ...
Is it better to monitor prostate cancer?
If you have intermediate- or high-risk prostate cancer, surveillance may not be the best option, especially if you are healthy or have a higher risk tumor. In these cases, it may be better to seek treatment to slow disease progression, even if that means having to deal with side effects like incontinence or erectile dysfunction.
Can prostate cancer spread without treatment?
But some patients may worry the cancer may spread without active treatment. Typically, the cancer is closely monitored, and delayed treatment can be offered (before the cancer has spread) ...
Can you get hormone therapy for prostate cancer?
You may also get hormone therapy along with radiation therapy. Side effects and eligibility for each treatment can vary by patient, and choosing between surgery and radiation is often an individualized decision. Standard options for high-risk prostate cancer can include a combination of surgery, radiation therapy, and/or hormone therapy.
