What is Active Surveillance?
- The National Comprehensive Cancer Network has reversed its new prostate cancer guidance, specifically about active surveillance.
- Active surveillance is a “watch-and-wait” approach for men with low-risk prostate cancer, meaning you have a small number of cancer cells found in your biopsy, a low PSA and a low-grade cancer.
- Active surveillance is typically enough for men with low-risk prostate cancer. However, if you’ve been diagnosed with moderate-risk cancer, it can be a slippery slope.
In September, controversy erupted within the medical community after the NCCN updated its prostate cancer guidance. (The NCCN, a nonprofit organization, is an alliance of 31 cancer centers across the United States, most of which are designated as comprehensive cancer centers.)
Read MoreNew @nccn #prostatecancer guideline. AS no longer “preferred” for low-risk?! 🤦â€â™‚ï¸ #whiskytangofoxtrot #pcsm @wandering_gu @DrSpratticus
HT @DanLinMD for noticing this… pic.twitter.com/6CW3ES4D81Matt Cooperberg (@dr_coops) September 28, 2021
However, on Tuesday, the NCCN reversed its guidance and reinstated its original recommendation that active surveillance is preferred. But there was a slight tweak made. The NCCN now recommends that "most" men with low-risk prostate cancer be offered active surveillance as the single "preferred" treatment option at the start of their cancer battle.
“Very glad to see this update! Great news and clarity for patients,” Dr. Cooperberg tweeted Tuesday afternoon.
New update @NCCN #prostatecancer: #activesurveillance once again “preferred” for most low risk disease. Very glad to see this update! Great news and clarity for patients.
Quick work by @EdwardSchaeffer @wandering_gu @urogeek et al.https://t.co/muCeTyATca pic.twitter.com/Ys8b25WGMJ
Matt Cooperberg (@dr_coops) November 30, 2021
Big news! NCCN guidelines updated again- active surveillance is "preferred for most patients" with low risk #prostatecancer and life expectancy of >=10y. Full version 2.2022 available online with free login: https://t.co/6G5Ya5VEPK https://t.co/J6PFcl1B8G
Stacy Loeb, MD (@LoebStacy) November 30, 2021
What is Active Surveillance for Prostate Cancer?
If you’re unfamiliar, you may be wondering what active surveillance is.
Active surveillance is what’s known as a “watch-and-wait” approach for men with low-risk prostate cancer, meaning you have a small number of cancer cells found in your biopsy, a low PSA and a low-grade cancer. What’s a PSA score? PSA stands for prostate-specific antigen. It’s a blood test that screens for the cancer; it can also track a person's response to cancer treatment. PSA is a protein secreted by the prostate gland; a large amount of PSA in a person's body can indicate that cancer cells are growing. (But that isn't always the case, and some SurvivorNet experts disagree on when to use this test, if at all.)
With low-risk prostate cancer, a man’s risk of cancer getting out of the prostate and spreading to other parts of the body is "really, really low," explains Dr. Stephen Freedland, a urologist at Cedars-Sinai Medical Center, "so anything we do is going to be overtreatment." If you do opt for active surveillance, you'll regularly need a PSA test, rectal exam and high-quality imaging tests, which can identify small yet important changes.
Choosing active surveillance means you avoid the potential side effects of treatment, including sexual and urinary problems. But it’s important to remember that about 50% of men who opt for active surveillance will have changes within five years that require active treatment, Dr. James Brooks, chief of urologic oncology at Stanford Medicine, tells SurvivorNet.
The Benefits of Active Surveillance
When is Active Surveillance Not Enough?
Active surveillance is typically enough for men with low-risk prostate cancer. However, if you’ve been diagnosed with moderate-risk cancer, it can be a slippery slope, some SurvivorNet experts say.
When the prostate cancer is considered at a moderate risk, many men choose to begin active treatment.
How do you know what risk level your cancer is? That’s determined by something called the Gleason score. The higher your score, the most aggressive your cancer. The Gleason score is still considered the ultimate indicator of the potential for prostate cancer to grow and spread. (The lowest Gleason score is 6, which is a low-grade cancer. A medium-grade cancer, or moderate risk, is a Gleason score of 7 and a high-grade cancer is a Gleason 8, 9 or 10.)
Active treatment involves surgery to remove the entire prostate, radiation or cryotherapy.
When is Active Surveillance Not Enough?
Contributing: SurvivorNet staff
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