Active Surveillance and Watchful Waiting are conservative management strategies for men with prostate cancer. They are two distinct strategies and need to be managed as such. This document gives an explanation of the two terms and aims to provide a structure for follow up for both.
The goal of active surveillance is to delay or avoid radical treatment in men with low-risk prostate cancer. The included patients are men with at least 10 years of life expectance who would be good candidates for curative prostate cancer management if evidence of higher-risk cancer was subsequently identified. In essence, these are men for whom a “trigger” is set for radical treatment, and if a certain PSA is reached, or repeat biopsy demonstrates higher-grade cancer, this treatment will be instituted. Due to the potential of these men to have a survival benefit from timely treatment, the Urology department will perform follow up PSA levels and organize imaging and biopsies as appropriate. If you believe your patient is in this group and it is unclear whether Urology Outpatients is following them, please let us know.
This term refers to a group of men with either a proven diagnosis of, or a high suspicion of prostate cancer that are unlikely to ever benefit from curative treatment of their cancer. They will tend to be older men, or those with significant comorbidity, and the intention of follow up is to institute palliative androgen deprivation therapy (ADT) at an appropriate time. Due to the significant adverse effects associated with ADT, therapy is usually delayed until absolutely necessary. As a rough guideline, a PSA doubling time of under 3 months, an absolute PSA level of 50-100, or symptoms possibly caused by prostate cancer (bone pain, lower urinary tract symptoms) may be indications for instituting ADT. PSA levels are usually taken at intervals of between 3 and 6 months. The timing of treatment is not critical as in Active Surveillance, and so monitoring can be carried out by the patients General Practitioner. The clinic letter should clearly state this and any variations to an individuals guidelines, and so if there is any confusion, please contact Urology Outpatients.
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