Does the tumor need treatment?
A growing number of men are being diagnosed with low-risk prostate cancer. For these men, the best initial treatment may be no treatment at all. Active surveillance is a treatment approach that recognizes the tumor as a long-term and likely slow-growing disease.
"An active surveillance approach may help select patients avoid potential complications from aggressive treatments that might negatively affect their current quality of life," explains Michael J. Wehle, M.D., a urologic surgeon at Mayo Clinic in Florida. "At the same time, it keeps the door open for treatment at a later date if necessary. Each patient needs to be evaluated carefully to see if he's a candidate for the active surveillance approach."
Active surveillance does not mean simply forgetting about prostate cancer. Rather, it involves closely following the tumor with regularly scheduled PSA tests and prostate biopsies. Given that the majority of men with low-risk prostate cancer will not have their cancer spread outside the prostate for many years, this approach enables doctors to follow the cancer to see if it shows any fast-growing characteristics.
If the tumor should start to grow faster than expected, curative treatment — usually radiation or surgery — should be offered. On the other hand, if the tumor appears to be indolent, any potential side effects associated with treatment can be avoided. Using this approach, many men have successfully avoided cancer progression and treatment side effects for more than a decade.
Active surveillance is not for everyone, but it's an option that should be discussed with and considered for all patients with low-risk disease. Decision-making criteria include both PSA levels and biopsy results. The best candidates are patients with:
- Low PSA levels
- Nonaggressive prostate cancer (as determined by biopsy)
- Small amounts of cancer (as determined by biopsy)
At Mayo Clinic, patients who choose active surveillance are followed long-term in a prospective database to see which tumors needed treatment and how successful that treatment has been. In addition, blood, urine and tissue samples are collected from these patients, which will be used to study new biomarkers that may help identify the tumors that are truly indolent.