Page 1 - Active Surveillance for Prostate Cancer
P. 1
Urological Health
Active surveillance
for prostate cancer
Prostate cancer often is very slow to progress. Some patients with low risk cancer may choose
close observation with no immediate active treatment.
he prostate is a gland wrapped around the urethra, The concept of active surveillance has more recently
Tthe urine channel, between the bladder and its been seen as a viable option for men who, for one
control muscle, the urethral sphincter. Its main function reason or another, have decided not to undergo
is to produce part of the semen ejaculated at male immediate surgery or radiation therapy. Active
orgasm. Each vas deferens carrying sperm from the surveillance is not just postponing treatment. For many
testicles connects to the prostate. The nerves carrying men who have slow growing or very early cancers,
signals to produce erections run on either side of the immediate treatment might not make sense. Instead,
prostate. active surveillance allows close monitoring with
subsequent treatment if it is decided that the cancer is
becoming more concerning. Active surveillance might
Side view of male lower urinary anatomy also be a good choice for men who have other serious
medical conditions that affect the way they live their
lives, or likely to shorten their lifespan.
Roula Drossis
bladder
seminal Prostate cancer risk
vesicle
sphincter prostate It is well known that prostate cancer grows more slowly
than others, and that some men are unlikely to get sick
rectum or die from their disease. Many reports have shown that
urethra erectile most men in their later years of life have evidence of
nerve prostate cancer but this latent or dormant cancer may
never progress or affect the patient. One large study of
men with early, low-risk prostate cancer that were only
watched carefully, with no active treatment, showed
that the majority did not die from their disease, even after
Cancer may develop in the prostate from which it can 20 years of follow-up.
grow into surrounding tissues or spread to other parts
of the body although most frequently the diagnosis However, the question of whether your cancer is more
of prostate cancer is made very early by an elevated or less aggressive can be difficult to predict. Cancer
PSA (prostate specific antigen) blood test. Microscopic aggressiveness can be determined to some degree using
examination of prostate biopsies confirms the suspicion available evidence that you have already discussed
of cancer and allows some prediction of the tumour’s with your doctor. The ones mostly widely used are
expected behaviour. This is known as the tumour grade tumor grade (Gleason score), PSA, and the extent of
or Gleason score. your tumor (stage). More favorable or low-risk prostate
cancer is often described as a Gleason 6 or less, a PSA
Additional investigations may be performed, when 10 or less, and early stage tumor based on your digital
necessary, to determine the extent or stage of the rectal examination (DRE). Intermediate risk cancer
cancer. Your prostate cancer appears to be confined includes Gleason score 7, a PSA between 10 to 20 or
to the prostate, although there is a chance of more advanced cancer on rectal examination. The
undetectable, microscopic spread. more aggressive the cancer, the higher the risk for early
spread to other areas of the body and therefore active
You have discussed several treatment options with your surveillance would be less of an appropriate option.
urologist, including:
• Active surveillance (observation without treatment;
sometimes called watchful),
• surgical removal of the prostate, and,
• radiation therapy (by external beam or
implantation of radioactive pellets, brachytherapy).
Continued on next page
Each option has its own advantages and risks.
