Clinical Opal - Active surveillance
Active Surveillance: A Patient-Centric Approach
Cameron is a 68 year old male who was diagnosed with low-risk prostate cancer six months ago.
Cameron says that he feels apprehensive about his diagnosis, knowing he is living with cancer but not treating it.
Cameron does not have a family history of prostate cancer and is otherwise well.
Cameron’s tests show Low Risk (Gleason 6 ISUP GG 1) disease and stable PSA. At this stage 6 monthly monitoring is indicated.
When would you consider implementing an active surveillance protocol and what information would you provide to support Cameron?
Understanding Active Surveillance: Minimising Risk, Maximising Care
Active Surveillance aims to prevent overtreatment and avoid treatment side effects in low-risk disease without missing higher risk disease and intervening if necessary. It is an active process of monitoring and reassessing patient risk at regular intervals. If a patient’s disease progresses while on active surveillance, active treatment would be reconsidered.
Active surveillance is suitable for a patient with at least 10 years life expectancy and fit for treatment of curative intent.
Criteria for Considering Active Surveillance
Active surveillance should be considered when a patient meets the criteria for Low Risk (Gleason 6 ISUP GG 1) disease and in select circumstances Low Intermediate Risk disease (Gleason 3+4=7 with low volume pattern 4, ISUP GG2), cT1-2, PSA <10 ng/mL
Empowering Patients like Cameron: The Benefits of Monitoring
Cameron should be reassured that due to regular monitoring any changes are likely to be detected early and appropriate intervention can take place in a timely manner, minimising the risk of overtreatment and unnecessary side effects. Monitoring is often a combination of regular PSA tests, MRIs and prostate examinations. The frequency of these tests is determined individually. Understanding recent advancements in screening, diagnosis and management is key to support appropriate shared decision-making with the GP and patient to optimise care for Cameron.
For further information join us for the Prostate health: advances in screening and assessment webinar bought to you by Healthy Male.
References:
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Tse, T, Wu, B, Vagholkar, S, Willcock, S (2023), Shared decisions making in prostate cancer screening: An update, Australian Journal of General Practice, Vol 52, Issue 3.
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The Royal Australian College of General Practitioners. Guidelines for preventive activities in general practice. 9th edn, updated. East Melbourne, Vic: RACGP, 2018. P104
Men’s Health Melbourne & Healthy Male Expert Advisor
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