Guidelines for the active surveillance of localized prostate cancer

This review summarized guidelines for the active surveillance of localized prostate cancer. The authors reported that active surveillance is a suitable strategy for the management of most low-risk prostate cancers provided appropriate monitoring protocols are followed.

Active surveillance refers to actively monitoring tumor growth and development of low-risk prostate cancer without actually administering treatment. Advances in the early detection of prostate cancer have led to a growing number of men living with low-risk prostate cancer. Many of these men are undergoing active surveillance. This review by the American Society of Clinical Oncology was conducted to provide guidelines for patient selection, monitoring frequency, and monitoring methods for active surveillance. 

For most men with low-risk localized prostate cancer (with a Gleason score of 6 or less, indicating less aggressive cancer cells), active surveillance is recommended. Some factors should be taken into account before deciding on treatment versus active surveillance in these patients. These factors include younger age (55 years or less), cancer in a larger area of the prostate (high-volume), African-American ethnicity, and patient preference. Treatment should also be considered for patients undergoing active surveillance who are reclassified to a higher-risk category. This could be due to either an increase in Gleason score or an increase in cancer volume.

Active treatment (such as radiation therapy or prostate surgery) is recommended for men with intermediate-risk localized prostate cancer (Gleason score of 7). Active surveillance may be offered in some cases of intermediate-risk localized prostate cancer. This would include in men with low-volume prostate cancer or in older patients (over 75 years).

The panel recommends that active surveillance methods should include blood tests measuring PSA levels (prostate specific antigen, an indicator of prostate growth) every 3 to 6 months, along with annual rectal examinations. Biopsies (tissue samples) of the prostate are recommended within 6 to 12 months after diagnosis. Biopsies should then occur every 2 to 5 years. Men with limited life expectancies may be offered watchful waiting instead of active surveillance. Watchful waiting would involve fewer biopsies.

Authors reported that active surveillance is a suitable strategy for the management of most low-risk prostate cancers provided appropriate monitoring protocols are followed.