What is Active Surveillance?

Active Surveillance (AS) is a strategy to manage early stage, low risk prostate cancer. AS actively follows patients in order to delay treatment-related complications. A decision to move on to treatment is triggered if there are signs that the cancer is becoming more aggressive or larger. AS has gained wide acceptance as a way to preserve and enjoy high quality of life while following a protocol to keep an eye on tumor activity. Anywhere from 30-50% of AS patients will go on to treatment within five years.

Who qualifies for AS?

A recommendation for AS is based on a diagnosis of low risk cancer and other factors:

  • PSA less than 10
  • Stage T2a or lower
  • Gleason grade 3+3
  • Patient age/life expectancy
  • Patient preference and lifestyle

Today, genomics may also be taken into consideration.

There may be exceptions to these guidelines. The decision to go on AS should be made in thorough consultation with your own doctor.

Some doctors still use the expression Watchful Waiting (WW). This is an older term that came into use for patients with medical conditions that ruled out surgery or radiation – so they were simply watched until pharmaceutical intervention was needed. By contrast, Active Surveillance means that in addition to monitoring patients are proactive. A program of dietary change, exercise and stress management techniques enhances the body’s genetic ability to inhibit tumor activity.

AS is not passive. It means taking responsibility for improving health and maximizing the body’s anticancer abilities.

A recipe for monitoring during AS

The PSA blood test and its variants (free PSA, total PSA, etc.) is an important ingredient for monitoring at prescribed intervals. Once a man is diagnosed with prostate cancer, a rise in PSA raises concern about a change in tumor activity. Usually another PSA test will be done within 3 months to confirm the rise. The digital rectal exam (DRE) is also a way to monitor for prostate gland changes. However, PSA and DRE are insufficient.

The most important ingredient: mpMRI

The most important ingredient in AS is an annual multiparametric MRI on a powerful 3T magnet (3T mpMRI). This is the Cadillac of prostate imaging, showing the size, shape, location and even aggression level of prostate cancer. When a patient is first diagnosed, he wait for 6 weeks to let the biopsy bleeding clear up, then undergo a 3T mpMRI as a portrait of his tumor. This becomes the baseline for comparison with each future monitoring scan. It will also reveal any significant cancer that was missed by the biopsy, in which case he may not qualify for AS. From then on, an annual 3T mpMRI provides superior monitoring, even if PSA and DRE remain stable.

During monitoring, if PSA/DRE becomes suspicious, the next immediate step should be mpMRI before a biopsy is done. With an expert scan and interpretation, mpMRI will reveal any new activity, rule a biopsy in or out, and stratify a patient’s risk.

3T mpMRI at the Sperling Prostate Center

The Sperling Prostate Center is a leader in prostate imaging. Dr. Dan Sperling and his expert staff have performed thousands of 3T mpMRI prostate scans. Dr. Sperling is recognized as an international authority in MRI detection, diagnosis and image-guided treatment of prostate tumors and BPH. Our Center features a state-of-the-art 3T magnet with patient-friendly design to minimize scan time. The benefit of our technology combined with Dr. Sperling’s many years of experience offers patients unparalleled excellence in prostate cancer imaging.

What if a biopsy is necessary?

Why in-bore MRI guided biopsy is best

  • Standard TRUS biopsy (12 or more needles) misses at least 30% of significant prostate cancer
  • TRUS biopsy has a greater risk of infection due to more needles
  • MRI/ultrasound Fusion guided biopsy is subject to distortion and inaccuracy. Fusion guided biopsy is often followed by random TRUS biopsies “to be safe”
  • In-bore MRI targeted biopsy uses minimum needles, and achieves maximum accuracy

If a biopsy is needed, the most accurate biopsy is a real-time MRI-guided targeted biopsy. While the patient is in the bore (tunnel) of the MRI, Dr. Sperling directs a minimal number of needles directly into the core of the tumor. This avoids overdetecting insignificant cancer by precisely capturing tissue from areas most likely to harbor dangerous cells. Fewer needles, better diagnosis.

3T mpMRI takes the guesswork out of AS by adding the assurance of top-shelf imaging. But remember: AS includes taking responsibility for your health, and maximizing your body’s ability to protect itself from cancer.

Multiparametric MRI is not the only ingredient for doing AS the right way – but it’s irreplaceable. Nothing else can provide the information needed to make best decisions about biopsy, treatment and follow-up. Dr. Dan Sperling and the Sperling Prostate Center offer AS patients the confidence that the monitoring they receive well exceeds the standard of care for Active Surveillance.

NOTE: This content is solely for purposes of information and does not substitute for diagnostic or medical advice. Talk to your doctor if you have health concerns or questions of a personal medical nature.

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