Active Surveillance for Prostate Cancer

Active surveillance, not the same as watchful waiting, is the decision to follow the prostate cancer closely after the time of diagnosis. Rather than treat the cancer, the physician monitors the PSA value at various intervals to assess whether it is increasing and at what rate (the PSA velocity). There are multiple ways to approach active surveillance; however, the concept remains the same throughout. First identify patients with lower grade, lower volume prostate cancer and then follow them closely with PSA readings and repeat biopsies at selected intervals to ensure that they continue to remain lower risk patients. Because active surveillance continues to evolve, it is vitally important that biopsies are repeated at specific intervals to ensure that they have not developed higher grade or higher volume disease that could spread more quickly outside of the prostate. Watchful waiting, however, is not the same as active surveillance. Active surveillance considers the possibility of a more aggressive and curable approach to prostate cancer, however watchful waiting refers to following those patients with a less than 10 year life expectancy. Watchful waiting does not have the stringent criteria and PSA and biopsy requirements associated with active surveillance. Currently the USMD PCC team has a strict criteria to place patients on the active surveillance protocol.

Gleason Score

A combination of the Gleason score from the pathology report, along with laboratory tests, imaging exams such as ultrasound and possibly an MRI or CT scan will help the physician determine the stage of disease.

Gleason ScoreGleason Score is the sum of two grades. Grades range from 3 for cancer cells that look almost normal to 5 for very abnormal cells that have lost most of the normal architecture of prostate cells. Cells with a grade 1-or 2 are still considered cancer although very low grade and rarely seen any longer. The primary grade is the most common pattern, and the secondary grade is second most common. The Gleason Score for prostate cancer range from 6 to 10. Higher Gleason scores mean the cancer is more likely to grow and spread more quickly. A higher primary grade also means more aggressive cancer. For Example: a Gleason score of 7 summed from primary and secondary grades of 4+3 is more aggressive than a grade of 3+4.



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