Active surveillance in practice – Review
DOI: https://doi.org/10.22591/magyurol.2023.2.beothet.79
Authors:
Beöthe Tamás Zsolt dr.
Déli-pesti Centrumkórház, Péterfy Sándor Utcai Kórház-Rendelőintézet, Urológiai Osztály (osztályvezető: Buzogány István dr.)
Summary
Active surveillance (AS) takes advantage of the prolonged natural course of prostate cancer. Active treatments are postponed and the patient is monitored according to a strict protocol. In case of progression, curative treatment is performed while the patient is still safely curable. The intention to treat is curative, aiming to minimize treatment-related toxicity without compromising survival.
The feasibility and safety of AS have been demonstrated in several studies, but the heterogeneity of studies means that guidelines are partly based on consensus.
For patients with low-risk disease and life expectancy over 10 years, AS should be considered as the standard first-line treatment of choice. AS can be recommended when ISUP 2 is associated with a tumour with PSA Rectal digital examination (at least annually) and PSA testing (at least every 6 months) are recommended during follow-up, as well as regular repeat biopsies. Histological sampling is necessary in case of PSA elevation or other suspicion (e.g. multiparametric MRI). The main indication for switching to active therapy is an increase in Gleason score or an increase in tumour area. The patient may decide to opt for active treatment at any time. If the life expectancy is less than 10 years, „watchful waiting” is recommended.
The importance of education should be stressed and the patient should be involved in the therapeutic decision together with the oncoteam.