Guidelines for active surveillance in low-risk prostate cancer

17 Feb 2016

For most men with low-risk prostate cancer, the recommended strategy is active surveillance with regular testing to check for cancer growth rather than immediate treatment, according to guidelines from the American Society of Clinical Oncology.

According to the University of North Carolina Lineberger Comprehensive Cancer Center member who first-authored a relevant report, recent recommendations aim to reduce unnecessary treatment for prostate cancer and potential long-term side effects from it.

"Active surveillance should be more commonly used for patients with low-risk prostate cancer, instead of radical prostatectomy or radiation treatment." said the report's lead author Ronald C. Chen, MD, MPH, a UNC Lineberger member and associate professor in the UNC School of Medicine Department of Radiation Oncology.

A framework for doctors and other providers on active surveillance

ASCO latest report provide practical guidance for urologists and other cancer specialists caring for prostate cancer patients by clarifying questions ranging from which patients are most appropriate for surveillance rather than treatment to when treatment should begin if a patient's cancer progresses.

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"These guidelines are trying to provide a framework for doctors and other providers on how to practice active surveillance, and to reduce variation in practice," Chen said. "Another important goal is to reduce the overuse of aggressive treatments that could cause harm to patients instead of benefit. Many patients with low-risk prostate cancer have a lower risk of dying from prostate cancer than from other causes."

Clarifying who should undergo "active surveillance" versus "watchful waiting”

The ASCO report recommends active surveillance for most patients with low-risk, localized prostate cancer, using regular monitoring with the prostate-specific antigen, or PSA, blood test, prostate biopsy and digital rectal exam. However, it does list exceptions for younger patients, African American patients, and those with high-volume cancer in the prostate -- because these patients are more likely to have cancer progression with active surveillance.

"The goal of active surveillance is to monitor patients carefully so that when the cancer starts to progress, you can offer treatment such as surgery or radiation and still have a high probability to cure the cancer," Chen said. The guideline warns against routine uses of additional tests such as MRI scans or genomic tests in active surveillance without further research.

"We don't have enough research yet to clearly show that these additional tests, which can be expensive for patients, improve patient outcomes," Chen said. The report also clarifies who should undergo "active surveillance" versus "watchful waiting." Chen said that active surveillance involves regular blood tests and biopsies, while watchful waiting involves stopping routine testing and may be appropriate for patients who are expected to live less than five years.

"For this group of patients with very limited life expectancy, we should stop surveillance, and instead, place them on what's called 'watchful waiting,' with no more PSA tests and no more biopsies," Chen said. "Because even these tests and procedures could have potential harms to patients."

Source: Science Daily

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