Discussion of Active Surveillance
Management of prostate cancer is constantly evolving. Two major trends are occuring that have led to a re-examination of how clinicans manage prostate cancer, particularly low risk, low volume disease.
1) Many clinicans recognize that not all prostate cancers reduce life expectancy. For many years prostate cancer diagnosed in older males has not been treated aggressively, but a "wait-and-see" approach has been adopted. In doing so clinians have tried to minimize the number of patients that experience side effects from different available treatments, particularly complications of long term hormonal suppression, incontinence and erectile dysfunction.
2) Increasing numbers of men are being diagnosed with prostate cancer. As PSA screening and biopsy techniques have improved more men are diagnosed with prostate cancer. However, many of these cancers are low risk and low volume and may not represent a threat to life expectancy.
The question becomes, which man needs therapy? and is there a group of men who will have prostate cancer that do not need therapy immediately if the disease will not impact their life expectancy (clinically insignificant disease)?
Recent guidelines from the National Comprehensive Cancer Network (2010) recognize that active surveillance is the most appropriate form of therapy for many men with low risk (Gleason 6), low volume (2 cores or less) prostate cancer.
Evidence for the support of active surveillance as a form of therapy comes primarily from two large scale trials.
Dr Klotz in Toronto, Canada has the longest running trial of active surveillance patients. Information on this cohort is available through this link. He discusses the START (Surveillance Therapy Against Radical Treatment) on the video link to the right.
The second large patient cohort is followed from Rotterdam, the Netherlands as part of the PRIAS (Prostate Cancer Research International - Active Surveillance) Project.
Considering Robotic Prostatectomy? Would you like a second opinion regarding your prostate cancer?
You can email Dr Berry directly - DrABerry.PVUrology@gmail.com. Or contact the office at 413 241 2100 for an appointment
daVinci Robotic Video
Dr Klotz - YouTube discussion of Active Surveillance
Dr Klotz - Discussion of START (Surveillance Therapy Against Radical Treatment) trial
