Urology Book


Active Surveillance of Prostate Cancer

Aka: Active Surveillance of Prostate Cancer, Canadian Prostate Cancer Surveillance Protocol
  1. See Also
    1. Prostate Cancer
    2. Prostate Cancer Management
    3. Prostate Cancer Composite Risk
    4. Prostate Cancer Very Low Risk
  2. Background
    1. Canadian protocol for Prostate Cancer active surveillance
    2. Avoids the risk of urinary, sexual and bowel dysfunction with Prostate Cancer Management
    3. Low risk Prostate Cancer mortality is 2.4% over 10 years
      1. Stattin (2010) J Natl Cancer Inst 102(13): 950-8 [PubMed]
    4. Active surveillance mortality in low risk Prostate Cancer is as low as 0.8% over 10 years
  3. Indications
    1. See Prostate Cancer Composite Risk for criteria
    2. Life Expectancy >15 years and
      1. See Charlson Comorbidity Index (Comorbidity-Adjusted Life Expectancy)
    3. Prostate Cancer Very Low Risk of progression
      1. PSA <10 ng/ml
      2. Gleason =6
      3. Stage T2a or less
      4. Prostate biopsy with <3 cores positive for cancer, less than 50% of cores involved, and PSA density <0.15
  4. Protocol: Surveillance
    1. PSA and Digital Rectal Exam
      1. Initial: Every 3 months for 2 years
      2. Later: Every 6 months
    2. Transrectal Ultrasound-guided biopsy with 10-12 core biopsies at one year and then every 3 years until age 80 years
    3. Consider transrectal Ultrasound on alternate exam dates
  5. Protocol: Intervention indications
    1. PSA doubling time <3 years based on =8 values
    2. Gleason Score progresses to =7
  6. References
    1. Brawley (2018) Am Fam Physician 97(12): 798-805 [PubMed]
    2. Klotz (2005) J Clin Oncol 23(32): 8165-9 [PubMed]

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