Active Surveillance

Prostate cancer is the most commonly diagnosed cancer in American men and the second leading cause of cancer death. The American Cancer Society estimates 241,740 new cases of prostate cancer were diagnosed, and 28,170 men died of prostate cancer in 2012. While 1 in 6 men will be diagnosed with prostate cancer during his lifetime, microscopic evidence of prostate cancer is found at autopsy in almost all elderly men following death from other causes. These findings, and the fact that prostate cancers generally grow slowly, suggest that not all prostate cancers are life threatening if untreated.

There have been advances in the treatment of prostate cancer with improvements in both efficacy of cure and minimization of side effects. However, not every prostate cancer requires immediate treatment, some cancers may be carefully monitored for years, and some cancers may not require treatment at all. Our goal here at the Columbia University Department of Urology is to use our experience with most effective treatments to help guide our patients in deciding which option best meets both, their medical needs and personal preferences.

What is Active Surveillance?

Active surveillance is an alternative to immediate treatment and involves the careful monitoring of 'low-risk' prostate cancers, and initiating curative treatment at a more appropriate time point, if necessary at all. Men with higher risk prostate cancer are more likely to experience progression if not treated immediately and therefore are not suitable for active surveillance. There are two important factors for a successful active surveillance program:

• Accurate identification of men with 'low-risk' prostate cancer
• Thorough and careful monitoring of men on active surveillance to recognize if and when a man requires and would benefit from treatment

Who is a Candidate for Active Surveillance?

Only men with cancers that are considered at low risk for spread or growth beyond the prostate are amenable to active surveillance. Higher stage and risk prostate cancers have a higher likelihood to progress and spread beyond the prostate if treatment is being significantly delayed.

As there are no definite rules as to who should or should not choose active surveillance, the physician's recommendation is based on an individual patient's age, clinical findings, and the patient's preferences. Criteria that help guide in the risk assessment of an individual's prostate cancer are based on levels of prostate-specific antigen (PSA) in the blood, microscopic evaluation of the prostate biopsy specimen, and imaging studies such as trans-rectal ultrasound, and Magnetic Resonance Imaging (MRI).

Why Active Surveillance?

With the implementation of PSA-screening in the mid-1990s, prostate cancers have been diagnosed more frequently and in the earlier stages. Given the slow growing nature of prostate cancer, several reports have criticized the wide-spread use of PSA-screening leading to an over-diagnosis and subsequent over-treatment in the United States. As mentioned, not every prostate cancer requires immediate treatment. The surgical and radiation treatment options can be associated with side effects (e.g. decreased erectile function and urinary incontinence). These problems do not occur in all men, but they are a risk with all treatment options, such as surgical removal of the prostate, cryotherapy, radiotherapy, or hormonal therapy. For patients with low risk prostate cancer who wish to maintain their current quality of life and defer intervention until they stand to benefit from treatment, active surveillance is an excellent option.

Who Can I Contact if I Have Questions Regarding Active Surveillance and Would Like to Schedule an Appointment?

Ultimately, the decision to pursue treatment or active surveillance is one that needs to be made together with the help of an experienced Urologist. Several of our faculty members are specializing in the diagnosis, surveillance, and treatment of prostate cancer, and can help guide you in your decision making.