Active surveillance for prostate cancer

Abstract

INTRODUCTION It is worth distinguishing between the two strategies of expectant management for PCa. WW entails administering non-curative androgen deprivation therapy to patients upon development of symptomatic progression, whereas AS entails delivering curative treatment upon signs of disease progression. The objectives of the two management strategies and the patients enrolled in either are different. AIM To review the role of AS as a management strategy for patients with low-risk PCa and review the benefits and pitfalls of AS. METHODS We performed a systematic review of AS for PCa in the literature using the National Center for Biotechnology Information's electronic database PubMed. We conducted a search in English using the terms: active surveillance, prostate cancer, watchful waiting, and conservative management. Selected studies were required to have a comprehensive description of the demographic and disease characteristics of the patients at the time of diagnosis, inclusion criteria for surveillance, and a protocol for the patients’ follow-up. Review articles were included but not multiple papers from the same datasets. CONCLUSIONS AS appears to reduce overtreatment in patients with low-risk PCa without compromising cancer-specific survival at 10 years. Therefore AS is an option for select patients who want to avoid the side effects inherent to the different types of immediate treatment. However, inclusion criteria for AS and the most appropriate method of monitoring patients on AS have not yet been standardized.

Low-Risk Prostate Cancer and Tumor Upgrading to Higher Patterns in the Surgical Specimen. Analysis of Clinical Factors Predicting Tumor Upgrading to Higher Gleason Patterns in a Contemporary Series of Patients Who Have Been Evaluated According to the Modified Gleason Score Grading System

“…Active surveillance (AS) is the management that is increasingly being performed as a strategy to avoid or delay the potential harm caused by unnecessary radical treatment in PCA patients who are unlikely to progress [4]. However, inclusion criteria for AS and the most appropriate method for monitoring patients on AS have not yet been standardized because of the evolving knowledge about PCA and the changes in risk assessment tools [5]. …”

Role of Prostate Specific Antigen Density for the Prediction of Radical Therapy Requirement in Localized Prostate Cancer

“…Günümüzde yeni tanı konmuş düşük riskli lokalize prostat kanseri hastalarında aktif izlem seçeneği alternatif tedavi yaklaşımı olarak giderek artan bir öneme sahiptir. Literatürdeki çalışmalarda, aktif izlem yaklaşımının prostat kanserine spesifik mortalitede %0-2 oranında etkili olduğu görülmüştür (11). Prostat kanseri tanısında ve aktif izlem kriterleri içinde yer alan prostat biyopsi sonuçları ile radikal prostatektomi sonuçları değerlendirildiğinde Gleason skorları arasında farklılıklar olduğu gözlenmiştir (12).…”

Molecular Imaging and Targeted Radionuclide Therapy of Prostate Cancer

“…The biologic characterization of prostate cancer is also a potential future application that may be used to personalize treatment plans. Differentiation of indolent from aggressive primary prostate cancer would be of enormous clinical benefit because many patients with primary prostate cancer currently undergo surgery or radiotherapy for a disease that might not have affected their health if it had remained untreated (20,21). Furthermore, many patients with recurrent prostate cancer die with, but not from, prostate cancer.…”