Active Surveillance for Prostate Cancer

One of the newest paradigms in prostate cancer care is to monitor eligible patients, those with low-grade prostate cancer, through an active surveillance program.

Active surveillance is the merging of watchful waiting and active management into a program that is interactive for the patient, ultimately allowing a man diagnosed with prostate cancer to monitor his disease and have the highest quality of life possible while delaying or even completely avoiding invasive treatments.

Cedars-Sinai’s active surveillance program involves monitoring a man’s prostate cancer on a regular basis using several elements, including a prostate-specific antigen (PSA) test, rectal exams and periodic biopsies or MRIs of the prostate. When appropriate, we use state-of-the-art technology that allows us to fuse MRI images to the ultrasound images used for the prostate biopsy.  This allows the urologist to directly biopsy the tumor seen on MRI, increasing the accuracy of the prostate biopsy.

If the disease progresses to the point where it becomes a threat to life, patients can then choose to undergo treatment.

When considering active surveillance, an oncologist will evaluate many things, including a man’s age, existing medical conditions, cancer stage and Gleason grade. These factors will help determine the men most suited for an active surveillance program.

For older men with a limited life expectancy, or for men with other serious health issues, it may be best to prolong or avoid prostate cancer treatments. It is vital to note, however, that any prostate cancer program or treatment, including active surveillance, is an extremely personal decision and should be made based on the individual patient and their specific medical condition and history.

An active surveillance program involves participants making necessary lifestyle modifications, including possible changes in diet and exercise. Many research studies have proven that an improved diet, coupled with exercise, could help decrease the risk of prostate cancer disease progression.  

Some men on active surveillance may be eligible to participate in various clinical trials to explore new monitoring or treatment options, as well as diagnostic, imaging and genetic-based advancements. One of the currently available clinical trials explores whether a plant-based diet rich in colorful vegetables, along with a healthy lifestyle, can help decrease disease progression and anxiety in men being treated with active surveillance.

Image: Active surveillance patient Charles Trevino remains physically active to decrease his risk of disease progression.