Active surveillance for low risk prostate cancer

Abstract

There is strong evidence that low risk and many cases of low-intermediate risk prostate cancer are indolent, have little or no metastatic potential, and do not pose a threat to the patient in his lifetime (clinically insignificant). We have made major strides in understanding who these patients are, and in counseling the use of conservative management in such individuals. A key component of this approach is the early identification of those “low risk” patients who harbor higher risk disease, and are likely to benefit from definitive therapy. This represents about 30 % of newly diagnosed low risk patients. A further small proportion of patients with low risk disease demonstrate biological progression to higher grade disease. The results of active surveillance, embodying conservative management with selective delayed intervention for the subset who are re-classified as higher risk over time based on repeat biopsy, imaging, or biomarker results, have shown that this approach is safe in the intermediate to long term, with a 3 % cancer-specific mortality at 10-15 years. Further refinement of the surveillance approach is ongoing, incorporating MRI and targeted biopsies. For patients with an identifiable target, focal therapy represents a complementary approach designed to conserve tissue and quality of life which eradicating the “index," or life-threatening lesion. Thermal ablation using focused ultrasound or interstitial laser, cryoablation, electroporation, and brachytherapy have all been applied in a focal fashion with promising results.