Active Surveillance in Prostate Cancer


Not all of men with newly diagnosed prostate cancer need immediate treatment.

While prostate cancer (PCa) is the most common non cutaneous cancer and second leading cause of cancer-related death in American men, it is conservatively estimated that we are over-treating 100,000 men per year in the United States who would be eligible for conservative treatment through active surveillance (AS).   The management of localized prostate cancer is controversial and men with localized disease diagnosed today often undergo treatments with significant morbidity that will not improve overall health outcomes.  The 2011 NIH State-of-the-Science Conference Statement on the “Role of active surveillance in the management of men with localized prostate cancer” pointed out the many unanswered questions about active surveillance strategies and prostate cancer that require further research and clarification. These included:

• Improvements in the accuracy and consistency of pathologic diagnosis of prostate cancer

• Consensus on which men are the most appropriate candidates for active surveillance

• The optimal protocol for active surveillance and the potential for individualizing the approach based on clinical and patient factors

• Optimal ways to communicate the option of active surveillance to patients

• Methods to assist patient decision making

• Reasons for acceptance or rejection of active surveillance as a treatment strategy

• Short- and long-term outcomes of active surveillance.

The consensus statement pointed out the need for well-designed studies to address these questions as an important health research priority.

The Brady Urological Institute has achieved world renown for discoveries that led to improvements in the surgical treatment of prostate cancer. However, not every man will benefit from treatment since some cancers will never progress to a harmful state. Researchers at the Brady Urological Institute have a commitment to learn how to identify those men who can safely forego treatment -instead undergoing careful follow up for any evidence of progression of their disease (active surveillance). An active surveillance program at the Brady Urological Institute under the direction of  Dr. Ballentine Carter  has followed more than 1100 men over more than 15 years who are thought to have tumors that can be safely managed without immediate treatment.

The Johns Hopkins Active Surveillance Program is unique:

  • Largest and longest ongoing surveillance study using strict criteria for recruitment developed at Johns Hopkins
  • Close follow-up of men, with annual prostate biopsies performed using techniques that are based on original studies from Johns Hopkins
  • Collection of blood and urine samples for future studies
  • Multidisciplinary team of dedicated urologists, pathologists, radiologists, statisticians, basic scientists, and clinical coordinators working together to improve patient care through discovery
  • Latest research findings translated into patient care before they become available to the medical community

 

For more information about the Johns Hopkins Active Surveillance Program:

http://www.urology.jhu.edu/prostate/advice1.php