Active surveillance

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Active surveillance describes a management option aiming at close monitoring of a specific stage in disease and minimizing adverse treatment-related effects without compromising survival at the same time. Curative or definite treatment is intended and offered upon deterioration or upon explicit patient request.

Usage

Active surveillance is implemented in diseases with slow progression or in low-risk patients not requiring immediate treatment and in which early curative treatment is associated with a lower quality of life and similar outcome as compared to no treatment. Follow-up is conducted according to a predefined schedule.

Active surveillance is an accepted management option in the following diseases:

Prostate cancer
Indications

Active surveillance is indicated under the following conditions :

  • low-risk prostate cancer (clinically insignificant prostate cancer)
  • intermediate-risk prostate cancer
    • Gleason Score: ≤7a (3+4)
    • in patients > 70 years and/or who choose not to have immediate radical therapy
Protocol

Recommendations as per NICE guidelines 2019 :

  • monitoring of PSA/PSAD and PSA velocity (every 3-4 months within the 1 year, every 6 months thereafter)
  • digital rectal examination (DRE) (every 12 months)
  • multiparametric MRI of the prostate (at 12 to 18 months)
  • clinical changes or PSA changes should prompt reassessment with mpMRI and/or repeat biopsy
Renal cancer
Indications

Active surveillance can be considered under the following conditions :

  • in patients of advanced age with medical comorbidities and
  • small renal masses suspicious for cT1a renal cell carcinoma (RCC) <2cm size
Protocol

Recommendations as per :

  • imaging follow up (every 6 months for 2 years and yearly thereafter)
  • quality of life assessment (at 6 months and 1 year and yearly thereafter)
  • chest imaging (annually)
  • progression (size < 4cm or growth 0.5 cm/year) should prompt intervention and standard of care

See also