You may be offered active surveillance if your prostate cancer is localised, deemed to be of a low risk and it is felt that you are unlikely to benefit from treatment. Generally the prostate cancer should be of a low grade (Gleason score 6 or less, sometimes expressed as Gleason score of 3+3) and your PSA stable and under 15 micrograms per litre. Active surveillance has been shown to be a safe strategy over many years. In our own series of over 200 men followed for up to 8 years, 95% remained on active surveillance (Bott British Journal of Urology 2005).
Active surveillance is based on the notion that most men, with time, will get prostate cancer but few men will die of it (3%). It is assumed, again quite logically, that men who are destined to die will undergo progression of their disease that can be detected and more importantly can be treated at a time before the disease has spread beyond the prostate.
The key is accurate risk classification at the onset. This usually involves MRI scans of the prostate and prostate template biopsies so that we can have a 95% certainty that the disease we think we are treating is indeed the disease that exists within the prostate.
Once the baseline is established, active surveillance is what it says. At regular intervals the PSA is checked. MRI can be done every 12 – 24 months. Many programmes include a re-biopsy at 24 months. This is less important if template biopsies have been done at the outset.
PSA density may also be used to determine your suitability for active surveillance. This is calculated by dividing your PSA level by the volume of your prostate. Generally men with larger prostates have a higher PSA level. You will usually need a PSA density of less than 0.15ng/ml/ml to be eligible for active surveillance.
Many men on active surveillance choose to optimise their weight, increase their exercise and sometimes change their diet. There is some evidence that some or all of these lifestyle changes do result in slower progression of prostate cancer. We can help with all these aspects of care.
- As there is no physical treatment, there are no physical side-effects
- It will not interfere as much with your everyday life as physical treatment would
- Some men may become anxious or worry about the cancer changing
- You may need to have more biopsies
- You will need to be seen fairly regularly