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Active Surveillance of Prostate Cancer

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Active Surveillance of Prostate Cancer, Canadian Prostate Cancer Surveillance Protocol

  • See Also
  1. Prostate Cancer
  2. Prostate Cancer Management
  3. Prostate Cancer Composite Risk
  4. Prostate Cancer Very Low Risk
  • Background
  1. Originally described here as Canadian protocol for Prostate Cancer active surveillance
    1. Has been studied for >15 years in the UK (ProtecT Trial) and US (PIVOT Trial)
  2. Has become a preferred option for management of low risk Prostate Cancer
  • Indications
  1. See Prostate Cancer Composite Risk for criteria
  2. Life Expectancy >15 years and
    1. See Charlson Comorbidity Index (Comorbidity-Adjusted Life Expectancy)
  3. Prostate Cancer Very Low Risk of progression
    1. PSA <10 ng/ml
    2. Gleason <=6 (or Grading Group 1)
    3. Stage T2a or less
    4. Prostate biopsy with <3 cores positive for cancer, less than 50% of cores involved, and PSA density <0.15
  • Efficacy
  1. Low risk Prostate Cancer mortality is 2.4% over 10 years
    1. Stattin (2010) J Natl Cancer Inst 102(13): 950-8 [PubMed]
  2. Active surveillance mortality in low risk Prostate Cancer is as low as 0.8% over 10 years
  3. Avoids the risk of urinary, sexual and bowel dysfunction without significant increased mortality
    1. Wilt (2017) N Engl J Med 377(2): 132-42 [PubMed]
    2. Donovan (2016) N Engl J Med 375(15): 1425-37 [PubMed]
    3. Hamdy (2023) N Engl J Med 388(17): 1547-58 [PubMed]
  • Protocol
  • Surveillance
  1. PSA and Digital Rectal Exam
    1. Initial: Every 3 months for 2 years
    2. Later: Every 6 months
  2. Transrectal Ultrasound-guided biopsy with 10-12 core biopsies at one year and then every 3 years until age 80 years
  3. Consider transrectal Ultrasound on alternate exam dates
  4. Other measures include Multiparametric MRI and biomarkers (see Prostate Cancer)
  • Protocol
  • Intervention indications
  1. PSA doubling time <3 years based on =8 values
  2. Gleason Score progresses to =7
  • References
  1. Brawley (2018) Am Fam Physician 97(12): 798-805 [PubMed]
  2. Hamdy (2023) N Engl J Med 388(17): 1547-58 [PubMed]
  3. Klotz (2005) J Clin Oncol 23(32): 8165-9 [PubMed]
  4. Xu (2024) Am Fam Physician 110(5): 493-9 [PubMed]