Active surveillance for localized prostate cancer

Active surveillance for localized prostate cancer

First to be seen and only in tumor progression to treat, according to the new guidelines, under specified conditions, an option for prostate cancer that has not yet exceeded the organ boundary.

Active surveillance (engl. active surveillance, AS) means of deferring principle possible curative (healing) treatment under close monitoring until the tumor progresses or the patient desires therapy. Contrast is meant by expectant monitoring (engl. watchful waiting, WW), long term observe the patient and initiate a palliative (palliative) treatment when the tumor causes symptoms (symptoms).

The aim of active surveillance is an "over-treatment", so to avoid unnecessary treatment to the person concerned the possible side effects of this treatment for the time being, or - to spare even permanently - if the tumor does not progress. Such a strategy lends itself to prostate cancer, which was discovered at an early stage because this grows very slowly in many cases and not in the lifetime of affected discomfort caused his death still leads.

At issue were previously the criteria by which to decide with sufficient certainty whether immediate action is needed, or whether one can wait. Here the S3 guideline of 2009 (see also has New prostate cancer guidelines ) finally brought clarity. For all studies were systematically collected on this subject and evaluated and derived recommendations for starting, control and completion of an active surveillance:

Conditions for the onset of active surveillance to be:

• PSA level to 10 ng / ml
• Gleason score to 6
• T stage T1c (tumor by needle biopsy found) and T2a (tumor in more than half a prostate page)
• Tumor involvement of more than 2 samples of prostate biopsy
• Tumor invasion by more than 50% of a sample

Patients should be informed about the possibility of active surveillance that are less than 70 years old, have no, or minor comorbidities and have a life expectancy of more than 10 years.
To identify a potential tumor progression in time, to regular check-ups are carried out, with

• Breast exam ( DRE ) and PSA testing in the first two years, every 3 months, then with a stable PSA level every 6 months
• Rebiopsie (repeat biopsy) every 12-18 months

The active surveillance is completed, so a treatment with curative intent are offered when

• the Gleason score in the Rebiopsie to more than 6 increases
• PSA doubling time ( PSA-DT ) drops to less than 3 years

These criteria are very strict and are therefore to ensure a high level of security: include only tumors with a low risk of progression and see short follow-up intervals and a premature termination due to deterioration before. So should not be worse than after immediate curative treatment, the entire tumor-specific (tumor-related) and the recurrence-free (relapse-free) survival rate after active surveillance and possible curative treatment.

In conscientious application of the criteria, especially with careful monitoring so the risk is very low to miss the right time to intervene. The regular physician contact also helps to cope with the psychological burden of the knowledge of living with an untreated cancer. The major advantage of active surveillance, however, is that numerous sufferers (only about 1/3 within 7 years) or not at all need to be treated until much later.

Ultimately, however, the decision depends not only on the findings, but also on the patient's wishes and numerous other factors. It can therefore only be taken individually after being informed of all treatment options.