What is Active Surveillance?
Active surveillance is a
treatment strategy used in the management of certain cancers, particularly those that are considered low-risk or slow-growing. Instead of proceeding immediately with more aggressive treatments such as surgery,
chemotherapy, or radiation, active surveillance involves closely monitoring the patient's condition through regular check-ups,
imaging studies, and laboratory tests.
How is Active Surveillance Conducted?
Active surveillance typically involves regular monitoring through
PSA tests (for prostate cancer), scheduled
MRI scans,
biopsies, and physical examinations. The frequency of these tests can vary but usually occurs every three to six months. The goal is to detect any signs of cancer progression early so that curative treatment can be initiated if necessary.
What are the Benefits of Active Surveillance?
One of the primary benefits of active surveillance is the avoidance of overtreatment and the potential
side effects associated with more invasive therapies. This approach allows patients to maintain a better quality of life while still keeping a close watch on their cancer. It is particularly beneficial for older patients or those with other significant health issues that make aggressive treatment riskier.
What are the Risks of Active Surveillance?
The main risk associated with active surveillance is the possibility of
cancer progression during the monitoring period. If the cancer grows or spreads, it could become more challenging to treat successfully. However, studies indicate that the risk of missing the window for curative treatment is relatively low when active surveillance protocols are followed correctly.
Who Should Consider Active Surveillance?
Patients with low-risk, localized cancers who prefer to avoid the potential complications of immediate treatment are ideal candidates for active surveillance. It is also an option for patients who have other serious health conditions that make surgery or other aggressive treatments less desirable. It is crucial for patients to have a thorough discussion with their oncologist to understand the risks and benefits specific to their situation.
When Should Active Surveillance be Discontinued?
Active surveillance may be discontinued if there are indications that the cancer is progressing. Signs of progression could include an increase in tumor size, a higher
Gleason score (for prostate cancer), or rising PSA levels. At this point, the patient and their healthcare team may decide to proceed with more aggressive treatments to control the cancer.
How Does Active Surveillance Differ from Watchful Waiting?
While both active surveillance and
watchful waiting involve monitoring cancer without immediate treatment, there are key differences. Active surveillance is more structured and involves regular and detailed monitoring with the intent to treat if necessary. Watchful waiting, on the other hand, is generally less intensive and is often used when the goal is to manage
symptoms rather than to cure the disease, usually in older patients or those with significant co-morbidities.
Conclusion
Active surveillance is a viable management strategy for certain types of cancer, allowing patients to avoid the potential
complications of immediate treatment while closely monitoring their condition. It requires a commitment to regular follow-up and a clear understanding of the risks and benefits. By working closely with their healthcare team, patients can make an informed decision that aligns with their overall health goals and personal preferences.
