If the physician has determined a low risk profile for your prostate carcinoma, treatment does not necessarily have to be started immediately. For slow-growing or non-growing prostate carcinomas, another option is available in the form of active surveillance, namely "non-treatment". Here, no therapy is initially carried out, but rather waiting to see whether the tumor grows. However, this is by no means a case of "passively waiting" or "doing nothing". If the patient opts for active monitoring, this is associated with regular check-ups.
However, if the first signs of disease progression appear, appropriate therapeutic measures are taken. The aim of Active Monitoring is to achieve a good quality of life while leaving open the possibility of therapy at a later stage.
Criteria for active monitoring
Patients in whom no clinically relevant tumor growth is to be expected due to the favorable expression and nature of the tumor or due to their age are eligible. The inclusion criteria for active surveillance are very strict. According to the current guidelines, the following parameters apply:
- PSA value ≤ 10 ng/ml;
- Tumor volume ≤ 1.3 ml
- Gleason score ≤ 6
- Stage: cT1 and cT2a;
- Tumor in ≤ 2 punches with removal of 10-12 punches.
- ≤ 50 % tumor per punch
Active Surveillance Procedure
For the first two years, the tumor is actively monitored every three months by PSA level, palpation and imaging, and every 12 months by repeat prostate biopsy. If the PSA value remains stable, the examination period is extended to six months. If the control biopsies show no change in the tumor during the first three years, tissue samples are taken only every three years thereafter.
If the PSA level rises during the period of active surveillance, this does not automatically mean that therapy must be given immediately if the increase is very slow. Only if the PSA value has doubled in less than three years or the control biopsy indicates a progression of the tumor, a new treatment strategy must be chosen together with the patient.
