Dr Crawford on the Evolving Role of Active Surveillance in Prostate Cancer

E. David Crawford, MD, professor of surgery and radiation oncology, head of the Section of Urologic Oncology at the University of Colorado Denver School of Medicine, and associate director of the University of Colorado Comprehensive Cancer Center, discusses the evolving role of active surveillance in patients with prostate cancer.

Various perspectives exist regarding active surveillance in prostate cancer, Crawford begins, noting that consensus is emerging around 2 primary objectives. First, a collective push has been made to minimize the number of individuals placed under active surveillance, he states. Secondly, for those under surveillance, a commitment must be made to diligently monitor their condition due to the likelihood that approximately one-third of these patients may harbor a more aggressive condition, Crawford says. Over a 10-year period, a considerable portion of individuals on active surveillance ultimately undergo treatment, he explains.

Discussions to improve active surveillance strategies have treatments to manage prostate enlargement and mitigate its influence in the surveillance process, Crawford expands. There is also consideration for incorporating additional markers to better monitor individuals on active surveillance programs, he notes. Traditionally, these programs involved annual biopsies, but there is a shifting trend away from this practice, Crawford explains. He says frequent biopsies may not always be necessary; instead, certain triggers, such as a rise in PSA levels or the emergence of new urinary symptoms, could prompt the need for biopsies according to established guidelines, he adds.

National Comprehensive Cancer Network Guidelines suggest that individuals falling within certain grade groups, typically 1 or occasionally 2, should be considered for active surveillance, Crawford continues. This recommendation is relatively recent and acknowledges that the approach to monitoring individuals on active surveillance can be more flexible and personalized based on specific triggers and individual circumstances, he explains. Therefore, the decision-making in terms of how individuals are monitored during active surveillance can vary based on clinical judgment and patient-specific factors, Crawford concludes.