Active surveillance is a management strategy for men with low-risk prostate cancer that involves closely monitoring the cancer with regular tests and exams, but delaying treatment until the cancer shows signs of progression. Here is a general summary of the protocol for active surveillance of prostate cancer:
Initial diagnostic tests:
A prostate-specific antigen (PSA) blood test, a digital rectal exam (DRE), multi-parametric MRI scan (mpMRI) and a biopsy of the prostate are performed to diagnose the cancer and determine its stage and grade.
Patient selection:
Active surveillance is typically recommended for men with low-risk prostate cancer, which is defined as a PSA level less than 10 ng/mL, a biopsy Gleason score of 6 or less, and clinical stage T1 or T2a. Low volume Gleason 7 prostate cancer could also be offered active surveillance.
Follow-up testing:
Patients undergo regular PSA blood tests, DREs, and repeat prostate biopsies at specified intervals, typically every 6 to 12 months. Imaging tests, such as MRI or ultrasound, may also be used to monitor the cancer.
Progression criteria:
The patient's PSA levels, DRE results, and biopsy findings are monitored for any signs of cancer progression. If any of these indicate that the cancer is becoming more aggressive, treatment may be recommended.
Treatment:
If the cancer progresses, the patient may be offered curative treatment, such as surgery or radiation therapy, depending on the stage and grade of the cancer.
Even after treatment, patients are monitored for several years with regular PSA tests and follow-up appointments to ensure the cancer has not returned.
The specific protocol for active surveillance may vary depending on the patient's individual circumstances and the preferences of their healthcare team.