A short history of “active surveillance”
Between 1967 and 1975, the Veteran Administration Cooperative Urological Research Group (VACURG) enlisted 111 men in a randomized trial comparing prostatectomy and active surveillance. Five, 10 or 15 years later, the percentage of those remaining in the study was similar in the two groups, 85, 43 and 20 percent after prostatectomy and 76, 48 and 16 percent with active surveillance.
Between 1989 and 1999, the Scandinavian Prostatic Cancer Group (SPCG-4) enrolled 695 subjects in another study comparing prostatectomy and active surveillance. This study revealed a difference for subjects less than 65 years old but not for older subjects. In the “less than 65 years old” group, the percentages for the 6-, 12-, or 15-year visits were 92, 73 and 43 percent after prostatectomy and 87, 55 and 33 percent with active surveillance. In the “65 years of age and older” group, the percentages were 87, 52 and 22 after prostatectomy and 89, 55 and 23 percent with active surveillance.
The Art of Risk Assessment
There is no scientific consensus concerning the optimal management of patients who decide to pursue active surveillance.
A study found that a “transperineal template biopsy” detects a more significant cancer in 34 percent of the patients who are otherwise candidate for active surveillance.
Variations in the PSA results, random or due to biological factors, can obscure a rising PSA, a short PSA doubling time, a high PSA velocity or a PSA inflection point.
Monitoring patients with ultrasound-guided biopsy may be inadequate since a recent 3-year surveillance studyshowed that the percentage of undetectable cancers with ultrasound-guided 12-core biopsies was 23%.
MRI Surveillance of Localized Prostate Cancer
The Departments of Urology and Radiology have established a new active surveillance program for patients who have a T1-T2a prostate cancer, confirmed by MRI, and not previously treated by surgery, radiation therapy, or hormonal therapy. In the UK, a study found that MRI has potential for monitoring patients who opt for active surveillance.
The patients under active surveillance will come for a clinical evaluation and a PSA test
every three months and will undergo a repeat MRI-guided prostate biopsy at the end of one year.
An Observational Study
If you decide to join our active surveillance program, your doctor will ask you to participate in a research study to identify the average surveillance time with the MRI surveillance program, document the experience of the participants, and compare the results of this program with those of other institutions. You can read the Informed Consent for this research study here.
Jerome Richie, MD
Michael O’Leary, MD, MPH
Graeme Steele, MD
Steve Chang, MD, MS
Clare Tempary, MD