Active Surveillance and How It’s Monitored
Active Surveillance (AS) is a strategy to manage early stage, low risk prostate cancer while holding off on definitive treatment. The intent is to avoid possible urinary and sexual side effects of conventional whole gland treatments (surgery, radiation). AS has gained wide acceptance as a way to preserve and enjoy quality of life while monitoring the cancer. Roughly 30-50% of AS patients will go on to treatment within five years.
The success of AS depends on monitoring, usually by periodic PSA blood tests and digital rectal exams. Also, most conventional protocols require repeat biopsy every 1-2 years to be on the safe side. However, another biopsy is triggered if a rising PSA and/or abnormal digital rectal exam suggest that the cancer is becoming more aggressive or larger. When this occurs, patients are sent for a repeat biopsy.
There is a problem with this monitoring method. PSA and DRE do not give sufficient information, so patients undergo repeat TRUS biopsies. TRUS biopsy misses 30-40% of cancers, and studies show that repeat biopsies often miss the same places. The risk of biopsy side effects increases with each repeat biopsy. However, there is a better way to monitor during AS.
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
- Psychological tolerance for leaving cancer in the body
- 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.
The Sperling Prostate Center solution
Men on Active Surveillance may NOT need an immediate TRUS biopsy if their PSA starts to rise.
The way to overcome the shortcomings of conventional PSA/biopsy monitoring is BlueLaser™ 3T mpMRI of the prostate. This is the Cadillac of prostate imaging—showing the size, shape, location and even aggression level of prostate cancer. About 6 weeks after initial diagnosis (time to let post-biopsy bleeding clear up) we provide a baseline mpMRI as a starting portrait for tracking a patient’s tumor while on Active Surveillance. This imaging becomes the basis for comparison with each future monitoring scan. It will also reveal any significant cancer that was missed by the first biopsy, in which case the patient may not be a candidate for AS. From then on, in addition to PSA tests at prescribed intervals, an annual 3T mpMRI provides superior monitoring, even if PSA and DRE remain stable.
However, if PSA/DRE becomes suspicious, the next immediate step is mpMRI before a biopsy. With our expert scanning and interpretation, BlueLaser™ 3T mpMRI shows any new activity, rules a biopsy in or out, and stratifies a patient’s risk. Some national guidelines allow mpMRI to replace repeat biopsy in patients with suspicious PSA results (e.g. rising PSA or short PSA doubling time.)
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.
4 Reasons In-Bore mpMRI-Guided Biopsy is Best
- Standard TRUS biopsy (12+ 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
What if a biopsy is necessary?
If after MRI imaging it’s determined that further testing is needed, real-time MRI-guided targeted biopsy will be the most accurate biopsy availebl. 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 and more accurate diagnosis take the guesswork out of AS.
Remember, Active Surveillance is not passive. It means taking a proactive role in monitoring your health and fostering wellness without letting cancer or its treatment rule—or debilitate—your life. Diet, exercise, and stress management all play a vital role in AS, as they enhance the immune system and maximize your body’s cancer-fighting abilities.
Multiparametric MRI is not the only ingredient for doing AS the right way—but it’s irreplaceable. In combination with periodic PSA tests, it gives the best information needed to make best decisions about AS, biopsy, treatment, and follow-up. We offer AS patients the confidence that the monitoring they receive well exceeds the standard of care for Active Surveillance.
More Accurate Active Surveillance
Take the anxiety out of AS by adding the most accurate imaging system to your AS plan. Request a consultation with Sperling Prostate Center today and get proactive about active surveillance