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How Long is Active Surveillance for Prostate Cancer?
How long should you undergo active surveillance if you have low-risk Prostate Cancer (PCa)? According to my experience compared to the study linked below, active surveillance among low-risk PCa patients can vary- a lot.
Though my original cancer diagnosis was multiple myeloma and not prostate cancer, I pay close attentional to all things PCa because there is prostate cancer in my family.
My personal experience of a PCa patient who was diagnosed with low-risk prostate cancer was a classmate of mine named Bill (not his real name). At the time of diagnosis Bill was 55 and his father, who was diagnosed with PCa, had undergone treatment long before Bill diagnosis.
Within about five years of Bill’s undergoing active surveillance for his PCa, a biopsy indicated high-risk form of PCa and Bill then decided to undergo active treatment.
Bill had been prehabilitating and underwent a local prostatectomy with no short or long-term side effects.
What are the pros and cons of active surveillance for Prostate Cancer patients?
Pros:
- Avoidance of Treatment Side Effects: Since active surveillance delays or avoids aggressive treatment, patients are spared potential side effects such as urinary incontinence, erectile dysfunction, and bowel problems that can result from surgery or radiation therapy.
- Quality of Life: Patients on active surveillance often report a higher quality of life compared to those undergoing immediate treatment, as they can continue their usual activities without the physical and emotional burden of treatment.
- Preservation of Sexual Function: Active surveillance may help preserve sexual function in some patients, as they avoid treatments that can damage nerves and blood vessels involved in erectile function.
- Overtreatment Avoidance: Many prostate cancers are slow-growing and may not cause symptoms or shorten life expectancy. Active surveillance allows patients with low-risk or early-stage prostate cancer to avoid unnecessary treatment and potential harm from overtreatment.
- Psychological Well-being: For some patients, knowing they are actively monitoring the cancer and intervening only if necessary can reduce anxiety and stress associated with a cancer diagnosis.
Cons:
- Risk of Disease Progression: The primary concern with active surveillance is the risk that the cancer may progress over time, potentially becoming more aggressive and harder to treat if not detected early.
- Anxiety and Uncertainty: Living with the knowledge of having cancer that is being monitored rather than treated can cause anxiety and uncertainty for some patients and their families.
- Frequent Monitoring: Active surveillance requires regular check-ups, blood tests, and sometimes repeat biopsies, which can be inconvenient and may cause discomfort or anxiety for some patients.
- Potential for Missed Treatment Window: Delaying treatment until the cancer progresses may limit treatment options or make treatment less effective, particularly if the cancer becomes more aggressive or spreads beyond the prostate.
- Impact on Emotional Well-being: For some patients, the decision to defer treatment and live with the uncertainty of cancer progression can be emotionally challenging and may affect their overall well-being.
Factors that can effect active surveillance for prostate cancer
The duration of active surveillance can vary depending on several factors, including:
- the patient’s age,
- the patient’s overall health,
- the aggressiveness of the cancer,
- and the preferences of the patient and their healthcare team.
To summarize, the study linked below cites a 25 year term for active surveillance. But my friend Bill was much younger than the average patients in the study, had prostate cancer in his family and finally, had been undergoing prehabilitation leading up to his prostatectomy. I believe that this gave Bill more confidence that he could manage the side effects often associated with a prostatectomy.
Have you been diagnosed with PCa? Are you wondering about active surveillance versus treatment? If you’d like to learn more about cancer email me at David.PeopleBeatingCancer@gmail.com
Good luck,
David Emerson
- Cancer Survivor
- Cancer Coach
- Director PeopleBeatingCancer
How Long Should Active Surveillance Last?
“Men with low-risk prostate cancer who go on active surveillance rather than treatment are best followed-up for more than 15 years — and perhaps indefinitely — according one of the longest studies to date to look at the issue.
Previous studies have shown that active surveillance continued for 15 years is appropriate to identify men who progress and need treatment, but now data out to 25 years “suggest that meticulous follow-up is needed over a longer time if the chance for cure is not to be missed…”
Long-Life Expectancy Justifies Extended Surveillance
The prospective Göteborg study began enrolling men with very low- or low-risk (78%) or intermediate-risk (22%) prostate cancer in 1995. In the active surveillance program, prostate-specific antigen (PSA) was measured routinely with biopsies ordered for PSA levels ≥ 2.5 ng/mL…
In an analysis published in 2016 when 202 (43%) of 474 patients managed with active surveillance had discontinued surveillance to start treatment, the median follow-up period was 8 years.
The rate of mortality associated with prostate cancer at 15 years was estimated to be
- 0% for men in the very low-risk group,
- 4% for men in the low-risk group,
- and 10% for those with intermediate-risk tumors…
In the most recent follow-up, when the median age in the Göteburg-1 study was 80 years (the median age at diagnosis was 66 years), the median follow-up period was 15.1 years with a range of up to 28.1 years.
In this analysis, which focused on patients with low-risk prostate cancer at baseline, discontinuations from active surveillance had climbed to 47%. Most of these men discontinued to initiate treatment, but 79 (16%) had failed acute surveillance, meaning their progression was not caught in time for curative-intent treatment, and 2% had died from prostate cancer…
Treatment-Free Survival Falls to 31%
The rate of treatment-free survival, which was estimated to be 65% in the 15-year analysis published in 2016, had declined to 31%. The rate of failure-free survival was 59%, and prostate cancer-specific survival was 92%, according to the researchers…
The low rate of deaths from prostate cancer over the extended period is reassuring, Palmstedt said, but the main message from the new study is that active surveillance permits curative-intent treatment to be offered even after late follow-up. She emphasized that patients without progression by 15 years cannot be considered “safe.”
Active Surveillance Now More Common
Over the past decade, the proportion of men with prostate cancer managed with active surveillance has been rising steadily…
In a study published last year in JAMA Network Open, Cooperberg and his colleagues reported that rates of active surveillance rose from 26.5% in 2014 to 59.6% in 2021. However, given the value of the approach for avoiding overtreatment of men with low-risk prostate cancers, even that increase is not enough, he said…
“The window of opportunity for cure is typically very wide,” Cooperberg said. Although many men “will never need treatment…long-term surveillance is definitely important” for those that do, he said. The data from trials like Göteborg-1 support the principle that this strategy still preserves the option of treatment when it is needed.
“Treatment for cure at age 70 is generally far preferable to treatment at 55, and surveillance should absolutely be preferred treatment for the vast majority of men with low-grade disease at diagnosis,” he explained…