Why do precision diagnostics make active surveillance less common?
Active surveillance is usually recommended when a detected cancer has a very low risk of spreading in the next 10 years.
A typical patient we’d recommend for active surveillance would be ‘elderly’ with a PSA less than 10ng/ml and a Gleason score on biopsy of 3+3=6 (known as Grade Group 1).
The obvious question is: why was this cancer detected? Usually, it’s a consequence of performing a ‘belt and braces’ biopsy when there’s nothing to see on the MRI.
At BPS, we very rarely biopsy patients who have no lesion that’s visible on an MRI scan.
What are the problems with active surveillance?
Active surveillance is conducted via a series of regular PSA blood tests and occasional repeat MRI scans or biopsies. The problem is that PSA results can quite randomly fluctuate up and down, which means that the link between the PSA and the danger of cancer spreading is pretty arbitrary.
If your PSA is rising faster than expected, an MRI scan may be performed. If there’s a change in the MRI, that’s often seen as a sign of progression. But how much of a change is clinically significant is also arbitrary.
Occasionally, repeat prostate biopsies will show that there’s grade progression, but this can also be subject to error, as biopsy results can depend on how the samples were taken.
That’s why PSA is sometimes said to stand for ‘Promoting Stress and Anxiety’. And that’s never our aim at BPS.
Ask smart questions
If you’re on active surveillance, ask exactly what you’re waiting for. If the answer is for the cancer to get more aggressive and more dangerous, then it’s worth knowing that evidence suggests that delayed treatment does not impact your chances of survival, but it probably does impact what sort of treatments you’ll be offered.
If there’s a visible lesion on an MRI scan, then it’s worth initiating a discussion as to why precision diagnostics and a highly effective focal therapy aren’t being considered instead of active surveillance.
Ready to take the next step?
If you have worrying symptoms you’d like to get checked, need a second opinion or just want a free chat with one of our nurse specialists, get in touch. Our friendly team will take care of the rest.