Search
active surveillance or prostate cancer
Indications:
- prostate cancer with favorable prognosis
- T1c, PSA density <0.15 ng/mL, Gleason score <=6, <=2 positive biopsy cores, & <=50% of a core involved
- <=T2a, PSA <10 ng/mL, & Gleason score <=6
Procedure:
- a structured, prospective management approach
- monitoring with serial
- prostate-specific antigen (PSA) testing
- digital rectal examination (DRE)
- prostate biopsies
Notes:
- it is not clear how much better this is than observation & how much of this is necessary for full benefit, i.e. serum PSA alone every 6 months or annually
- it is not clear why a digital rectal examination adds much when a prostate biopsy will be done regardless
- finanicial incentives for urologist to biopsy patients with low-risk prostate cancer is not discussed [1]
General
cancer management
References
- Tosoian JJ, Mamawala M, Epstein JI et al.
Intermediate and longer-term outcomes from a prospective
active-surveillance program for favorable-risk prostate cancer.
J Clin Oncol 2015 Oct 20; 33:3379.
PMID: 26324359
http://jco.ascopubs.org/content/33/30/3379
- D'Amico AV.
Personalizing the use of active surveillance as an initial
approach for men with newly diagnosed prostate cancer.
J Clin Oncol 2015 Oct 20; 33:3365.
PMID: 26324374
http://jco.ascopubs.org/content/33/30/3365