A subsidiary of the University Medical Center Hamburg-Eppendorf

A subsidiary of the University Medical Center Hamburg-Eppendorf

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Active surveillance – the right choice for certain patients

What is active surveillance?

Active surveillance (AS) is a treatment strategy for prostate carcinoma. It is a monitoring strategy with selective delayed intervention. This means that treatment for the prostate carcinoma is postponed until the doctor detects indications that a tumour is starting to grow more aggressively. Active surveillance is only safe in patients whose tumour is confined to the prostate and displays low aggressiveness. It is usually offered as an option in older men in poor health in order to avoid overtreatment and the risks and side effects of other treatment methods. Many of these men will not experience any symptoms of their prostate tumour during their lifetime. 

Active surveillance does not involve any invasive treatment to begin with. Instead, the status of the disease is monitored through a carefully coordinated schedule of doctor’s check-ups. The patient’s PSA level is measured on a regular basis, with palpation (digital rectal examination) and prostatic tissue samples (control biopsies) at regular intervals. As soon as the doctor detects that the tumour has become more aggressive, the patient is offered invasive treatment such as surgery or radiotherapy. Active surveillance can also be a treatment option for younger men who want to put off the potential side effects of invasive treatment for as long as possible. However, sufficient research is lacking on the risks of active surveillance in younger men. 

What are the risks of active surveillance?

Some prostate tumours grow very slowly and may have little impact on a patient’s life expectancy depending on the their age when the cancer is detected. It is unlikely that such prostate tumours would ever cause issues or that patients would die from them. However, it is not possible to exclude the risk that a slow-growing tumour will suddenly become a fast-growing tumour without being detected and spread beyond the prostate – and that this situation will not be identified in time. Theoretically, there is a risk that the tumour will then become inoperable and incurable by radiotherapy. 

It is possible that a tumour will become more aggressive and necessitate invasive treatment when a patient is much older. In such cases, it is vital to consider that older patients have a much higher risk of experiencing side effects following invasive treatment and also take longer to recover. 

Active surveillance requires regular visits to the doctor for PSA tests, palpation (rectal examinations) and prostate biopsies. 

Having cancer and leaving it untreated can be a major psychological burden for some patients. Before opting for active surveillance, some men find it helpful to speak with a psycho-oncologist – a service we offer at the Martini-Klinik. 

What are the benefits of active surveillance?

For some patients with a very slow-growing tumour, there is a good chance that their prostate carcinoma will never actually cause a problem or require invasive treatment. Studies have shown that patients with a less aggressive tumour have the same life expectancy as men with the same class of tumour who undergo radiotherapy or surgery. In addition, active surveillance does not entail the potential risk of impotence or incontinence. However, it is still not possible to make a conclusive assessment of the potential risks and benefits of active surveillance. We will have to wait for long-term studies for a definitive analysis. This is why we offer all patients interested in active surveillance the opportunity to include their experiences in a study, such as the PRIAS Study (Prostate Cancer Research International: Active Surveillance). 

Active surveillance is only an option for tumours with a low level of potential aggressiveness. It is important to carry out a careful and detailed analysis and weigh up whether all of the requirements for active surveillance have been met.

You can decide to stop active surveillance at any time and start treatment right away.

Prof. Dr. Hans Heinzer

What is active surveillance of prostate cancer?

Active surveillance does not involve any invasive treatment to begin with. Instead, the status of the disease is monitored through a carefully coordinated schedule of doctor’s check-ups. The patient’s PSA level is measured on a regular basis, with palpation (digital rectal examination) and prostatic tissue samples (control biopsies) at regular intervals. As soon as the doctor detects that the tumour has become more aggressive, the patient is offered invasive treatment such as surgery or radiotherapy.