Active Surveillance of Prostate Cancer

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Active Surveillance of Prostate Cancer may be appropriate for low-grade Gleason scores judged by a prostatic biopsy analysis by looking at tissues through a microscope

Professor Mark Frydenberg AM, talks about active surveillance for prostate cancer and its preference to radiation or surgery for low-grade prostate cancer.

Video Transcript

I’m Mark Frydenberg, one of the urologists at Australian Urology Associates, and I wanted to talk to you today briefly about active surveillance for prostate cancer.

In some of our other videos in our series we would have discussed PSA based screening, what PSA is and also the Gleason grading of prostate cancer

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As you would have heard in those videos, if you’re diagnosed with a relatively small low-grade prostate cancer namely a Gleason-6 tumour or Gleason-grade group one tumour, often the likelihood of that cancer growing and spreading is actually very low. Its growth rate is likely to be measured in years, sometimes decades, and in many cases the cancer may not ever cause death of the patient. As such, rushing in to do treatments, such as radiation or surgery, that do carry some potential side effects may in fact be unnecessary and close surveillance is indicated.

Now, this is an active process; this isn’t a set and forget where we just tap you on the back and say everything is fine, you do need to be monitored very carefully.

This would mean having your PSA blood test done approximately three-monthly. At the end of the first year, you would need to have a repeat MRI scan, and you may in fact be advised even to have a repeat biopsy to be absolutely certain that the cancer was not progressing or growing or becoming more aggressive.

Once confirmed at the one-year mark that the cancer was not becoming any more aggressive or larger, then it’s generally safer to continue on surveillance for longer periods of time, and although you’ll continue to do the blood test every three months, it is more likely that there will be greater intervals in between the MRIs and potentially repeat biopsies; and as long as your PSA remains stable, and your examinations are also normal, we can be confident that you would only need to have an MRI perhaps every three years to make sure that the cancer was not progressing.

All of the urologists here at Australian Urology Associates have many patients that have successfully been on surveillance for sometimes 15, 20 years and greater, so it’s important to be very comfortable and reassured that this is a very safe way of dealing with low-risk prostate cancer. In fact, most published series have shown that the death rate of prostate cancer after 10 years on active surveillance is only in the order of one percent.

As such, this is very safe, as long as you’re compliant and follow your urologist’s instructions to make sure that you do, do your blood test regularly and to follow using their instructions with regards to having repeat MRI scans and biopsies when it’s indicated.

Thanks very much for your attention.