Prostate Cancer

Active Surveillance

Some prostate cancer is aggressive and requires treatment to prevent it spreading or causing death. Most prostate cancer however, is low-risk, tends to grow slowly and rarely spreads.

Men with slow growing, low-risk prostate cancers tend to die of non-prostate cancer causes. As urologists we therefore recommend Active Surveillance (AS) rather than treatment to men in this group. Active surveillance consists of regular blood tests, examinations, MRI and biopsies aimed at identifying cancer progression. Cancers that lie dormant over time can continue with surveillance, those that show signs of progression require treatment.

PRIAS Study

The PRIAS study is the largest continuous study of men undergoing AS for prostate cancer. The following questions about AS were answered in the study:

How many men continue on AS?
  • At 5 years about 50% of men were still on AS
  • At 10 years about 25% of men were still on AS
Why did they discontinue AS?

Of the men that discontinue AS about 2/3 are due to cancer progression and 1/3 due to patient desire for treatment

Of the men who stopped AS and then underwent radical prostatectomy how bad was their disease?

Pathology showed 2/3 had intermediate or high risk prostate cancer and 1/3 had low-risk prostate cancer

How many men on AS developed incurable disease because they chose AS?

Of the 5000 men enrolled in the study about 50 developed incurable disease by the end of the 10 year period. This is a rate of about 1%. Of these:

  • 30 had positive PSA after undergoing treatment
  • 10 had local recurrence in the pelvis
  • 8 had metastatic prostate cancer
  • 1 man died
Protocol

Mr Thyer will follow the following protocol for all men on AS:

  • PSA 6 monthly
  • Prostate examination yearly
  • Repeat MRI and biopsy at 1, 3, 7, 12 years
Advantages of AS
  • Avoiding the side effects of treatment with surgery or radiotherapy
Disadvantages of AS
  • Anxiety of not treating the cancer
  • Multiple rectal examinations and biopsies
  • Chance of cancer progression or becoming incurable
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