Active surveillance

Overview

• Prostate cancer: NICE NG131 defines active surveillance as part of a curative strategy that keeps a man inside the window of curability, with radical treatment considered for those whose tumours show signs of progressing and for those who would prefer intervention. It is not the same as watchful waiting, which the same guideline defines as a strategy for controlling rather than curing, avoiding surgery and radiation and deferring hormone therapy.
• NICE NG131 (1.3.14, table 2) gives the protocol: PSA every 3 to 4 months through year 1, PSA kinetics monitored throughout, a digital rectal examination at 12 months, a multiparametric MRI at 12 to 18 months, then PSA every 6 months and an examination every year, with MRI or repeat biopsy whenever there is concern. NG131 (1.3.8) offers surveillance first for CPG 1, (1.3.9) as one of three choices for CPG 2, (1.3.10) as an option for CPG 3 men who choose not to be treated immediately, and (1.3.11) not at all for CPG 4 and 5.
• In ProtecT, at a median of 15 years, 133 of the 545 men in the active-monitoring group (24.4 percent) were alive with no prostate cancer treatment of any kind; death from prostate cancer had occurred in 17 (3.1 percent) of that group against 12 (2.2 percent) after prostatectomy and 16 (2.9 percent) after radiotherapy, a difference that was not statistically significant.