For prostate cancer patients, active surveillance is a valid option

26 Aug 2014

Active surveillance offers low-risk prostate cancer patients a means to avoid the potentially harmful side effects from treatment. The latest recommendations help determine which low-risk prostate cancer patients are good candidates.

The recommendations were published from the Archives of Pathology & Laboratory Medicine.

What is active surveillance for prostate cancer?

With active surveillance, patients undergo regular visits with prostate-specific antigen (PSA) tests and repeated prostate biopsies rather than aggressive treatment. It is distinguished from watchful waiting, in which treatment for localized disease is withheld and palliative treatment for systemic disease is initiated.

"Active surveillance is an important management option for men with low-risk prostate cancer," says lead author Mahul Amin, MD, FCAP, Chair, Department of Pathology & Laboratory Medicine, Cedars-Sinai Medical Center, Los Angeles, CA. "Vital to this process is the critical role pathologic parameters play in identifying appropriate candidates for active surveillance."

Identifying patients for whom active surveillance is appropriate

Dr. Amin spearheaded the team that highlighted the pathologic parameters key for the successful identification of patients likely to succeed with active surveillance. 

The key parameters, at a general level, address:

  • Sampling, submission, and processing issues in needle biopsies used to diagnose prostate cancer
  • Tumor extent in needle biopsies
  • Biopsy reporting for all and special cases
  • Gleason scores, the system for grading prostate cancer tissue based on how it looks under a microscope
  • Precision medicine markers
  • Other pathologic considerations

The team further concluded that the key parameters to be reported by the surgical pathologists:

  1. need to be reproducible and consistently reported and
  2. highlight the importance of accurate pathology reporting.

Recommendations from the United States Preventive Services Task Force, an independent group of national experts in prevention and evidence-based medicine, and randomized trials have drawn attention to overtreatment of localized, low-risk prostate cancer. PSA screening and changing consensus on PSA testing practices are among the many factors that contribute to prostate cancer's overdiagnosis and overtreatment.


Source: Science Daily

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