Active Surveillance

Active Surveillance

Prostate cancer in some patients follows an indolent course. On the other hand, treatment for prostate cancer has side effects. In order to address these concerns but at the same time, not miss the golden opportunity to treat the patient effectively, concept of active surveillance became popular. Especially in the western countries where patients' awareness is high, many patients are diagnosed at an early stage. Hence monitoring the cancer progress and intervening at an appropriate opportunity is a possibility. Recently many centres in the West have started the Active Surveillance protocols and there is increasing evidence in the medical literature that this method does not harm patients in short to intermediate term. In short, a select set of patients which are diagnosed with low risk prostate cancer are monitored closely with an idea to intervene, if necessary, in future


What does it entail?

It entails appropriate diagnosis, staging investigation which in turn leads to correct patient selection for the Active Surveillance protocol. Once selected, the patients follow a 3 monthly regime of PSA and DRE & Transrectal biopsy of the prostate at 1, 3 &5 years of follow up. At any point of time in the follow up,, if there is an increase in PSA, change in DRE findings , increase in grade / volume of cancer on biopsy, the patient will be switched on to active treatment plan


Advantages

The patient will be avoiding the side effects of treatment (incontinence, impotence) at least for a period of time. It is possible that some patients may not need treatment at all for the life time


Disadvantages

Many patients find it difficult to live with the idea that they have cancer but is not treated. Their anxiety and concern may have a negative impact on their mental and physical health. This may lead them to choose to have treatment rather than monitoring. During the monitoring process, it is possible , the cancer may progress , which in turn , may reduce the chances of cure. There are limitations of pathology obtained in needle core biopsy and radiological imaging. Hence it is possible that patient has more aggressive cancer than what is reflected in the tests done during diagnostics.


Active Surveillance in India

The patients with prostate cancer diagnosed in India are inevitably in either locally advanced stage or at advanced stage . In addition many patients have aggressive cancer as well. So the number of patients who would be eligible for monitoring is low. In addition the anxiety factor , coupled with the costs of monitoring , motivates many to undergo treatment.