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Principal Investigators: 
Mrs. M.J. Roobol, Assoc. Prof., MSc
+31 10 7032 240
Mr. C.H. Bangma, Prof. Dr. M.D.
+31 10 703 36 07
Database management:
Mr. F-J. Drost M.D.
+31 10 7032 243
Mr. A. Alberts M.D.
+31 10 7032 243
Site management:
Mr. W. Roobol
Active surveillance of early prostate cancer


Screening has resulted in a marked increase in the number of newly diagnosed prostate cancers, while it is unclear whether the early detection of these tumors reduces the prostate cancer mortality. (1)

Up to 80% of men with PSA screen-detected prostate cancer are overdiagnosed, that is, their cancer would never have caused any symptoms. (2) Overdiagnosis would matter less if treatment had no adverse effects. (3,4)

It would be more acceptable to treat all cases, including those destined never to cause symptoms, if treatment was problem-free. However, while radical treatment for prostate cancer may or may not improve a man’s longevity, it can certainly have a big impact on his lifestyle. Ideally, such intervention should be restricted to those who need it. Active surveillance aims to individualize the management of early prostate cancer by selecting only those men with significant cancers for curative treatment. (5,6)

Patients on active surveillance are closely monitored using serum PSA levels and repeat prostate biopsies. The choice between curative treatment and continued observation is based on evidence of disease progression during this monitoring. Active surveillance must be distinguished from watchful waiting, which for decades has described a policy of observation with the use of palliative treatment for symptomatic progression. Put another way in order to emphasize the differences between these two contrasting approaches, whereas watchful waiting involves relatively lax observation with late, palliative treatment for those who develop symptoms of progressive disease, active surveillance involves close monitoring with early, curative treatment in those with evidence of biochemical or histological progression.

PRIAS (Prostate cancer Research International: Active Surveillance) presents a program in which selected men with early prostate cancer are managed by a protocolized follow-up strategy. Candidates for this program are: men fit for curative therapy, PSA at diagnosis less than 10 ng/mL, PSA density (PSA/prostatic volume) less than 0.20, one or two biopsy cores bearing prostate cancer (using a fixed volume-dependent number of cores), Gleason score 3+3 and digital rectal examination T1c or T2.

The current program is registered at the Dutch Trial Register with ID: NTR1718

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Contact Frank-Jan Drost or Arnout Alberts for more information.

References

1. Jemal A, Murray T, Ward E, et al. Cancer statistics, 2005. CA Cancer J Clin 2005;55(1):10-30.
2. Yao SL, Lu-Yao G. Understanding and appreciating overdiagnosis in the PSA era. J Natl Cancer Inst 2002;94(13):958-60.
3. Penson DF, Litwin MS, Aaronson NK. Health related quality of life in men with prostate cancer. J Urol 2003;169(5):1653-61.
4. Fransson P, Widmark A. Late side effects unchanged 4-8 years after radiotherapy for prostate carcinoma: a comparison with age-matched controls. Cancer 1999;85(3):678-88.
5. Klotz LH. Active surveillance with selective delayed intervention: walking the line between overtreatment for indolent disease and undertreatment for aggressive disease. Can J Urol 2005;12 Suppl 1:53-7; discussion 101-2.
6. Parker C. Active surveillance: an individualized approach to early prostate cancer. BJU Int 2003;92(1):2-3.

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Active Surveillance - Management of localized prostate cancer 2001 - 2014
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