Preventing clinical progression and need for treatment in patients on active surveillance for prostate cancer

Hanan Goldberg, Zachary W A Klaassen, Thenappan Chandrasekar, Neil Fleshner

Research output: Contribution to journalReview article

2 Scopus citations

Abstract

Purpose of review Active surveillance is an established treatment option for men with localized, low-risk prostate cancer (CaP). It entails the postponement of immediate therapy with the option of delayed intervention upon disease progression. The rate of clinical progression and need for treatment on active surveillance is approximately 50% over 15 years. The present review summarizes recent data on current methods, attempting to prevent clinical progression. Recent findings Patient selection for active surveillance is the first mandatory step required to lower progression. Adherence to active surveillance protocols is critical in making sure patients are monitored well and treated early when progression occurs. Before active surveillance allocation and during active surveillance follow-up, methods involving multiparametric MRI, prostate specific antigen derivatives, biopsy factors, urinary, tissue and genetic markers can be used to prevent clinical progression and/or identify those at risk for progression. Medications such as 5a-reductase inhibitors and others might inhibit disease progression in patients on active surveillance. Summary Active surveillance is required because of overdiagnosis, along with our inability to accurately predict individual CaP behavior. Several methods can potentially reduce the risk of CaP progression in patients with active surveillance. However, a measure of uncertainty and fear of progression will always accompany patients with active surveillance and the physicians treating them.

Original languageEnglish (US)
Pages (from-to)46-54
Number of pages9
JournalCurrent Opinion in Urology
Volume28
Issue number1
DOIs
Publication statusPublished - Jan 1 2018
Externally publishedYes

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Keywords

  • 5a-reductase inhibitor
  • Active surveillance
  • Multiparametric MRI
  • Progression
  • Prostate specific antigen

ASJC Scopus subject areas

  • Urology

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