Name of the Procedure:

Active Surveillance (AS) for Low Risk Prostate Cancer (PRCA)

Summary

Active Surveillance (AS) is a conservative management strategy for men with low-risk prostate cancer, involving regular monitoring of the cancer with the intention of avoiding or delaying more aggressive treatment unless necessary.

Purpose

Active Surveillance is recommended for low-risk prostate cancer to avoid the side effects of more aggressive treatments such as surgery or radiation. The goal is to closely monitor the cancer's progress and intervene only if there are signs of progression, ensuring a high quality of life while minimizing unnecessary treatments.

Indications

• Diagnosed with low-grade, low-volume prostate cancer
• Prostate-specific antigen (PSA) levels are low
• Gleason score of 6 or less
• Limited disease on biopsy and imaging studies

Preparation

• No specific preparation required, but patients should maintain regular follow-up appointments.
• Routine diagnostic tests including PSA blood tests, digital rectal exams (DRE), and periodic prostate biopsies.

Procedure Description

1. Initial Assessment: Confirm low-risk status via PSA testing, DRE, and biopsy.
2. Ongoing Monitoring: Scheduled follow-ups including periodic PSA tests (every 3-6 months), DREs, and repeat biopsies (typically every 1-2 years).
3. Decision Points: During follow-ups, if test results indicate cancer progression, the strategy may shift to active treatment options like surgery or radiation.

Tools, equipment, or technology used include PSA blood test kits, ultrasound for performing biopsies, and laboratory analysis for biopsied tissue.

No anesthesia or sedation is involved in monitoring processes like PSA tests and DRE, but local anesthesia may be used during biopsy procedures.

Duration

Active Surveillance can extend for many years, depending on the cancer's behavior and patient’s health status.

Setting

Monitoring occurs in an outpatient clinic or doctor’s office.

Personnel

• Urologist
• Oncologist
• Nurse
• Laboratory technicians

Risks and Complications

• Psychological stress due to living with untreated cancer
• Risk that the cancer may progress unnoticed between intervals of testing
• Minor risks associated with biopsy, such as infection or bleeding

Benefits

• Avoids or delays the side effects of surgery and radiation, such as incontinence and erectile dysfunction
• Maintains patient’s quality of life
• Personalized care tailored to the patient’s cancer behavior

Recovery

No significant recovery is needed as there's no surgical intervention. Post-biopsy care may involve managing minor bleeding or infection risks. Regular follow-up visits are critical.

Alternatives

• Radiation Therapy: Effective in eliminating cancer but has side effects like fatigue and urinary/rectal issues.
• Radical Prostatectomy: Surgical removal of the prostate, with potential side effects including urinary incontinence and sexual dysfunction.
• Brachytherapy: Placement of radioactive seeds in the prostate, with risks such as urinary symptoms and erectile dysfunction.

Patient Experience

Patients may experience anxiety due to the uncertainty of cancer progression. Regular follow-ups involve minimal discomfort. Management includes education on the procedure, psychological support, and addressing any concerns patients may have.