Active surveillance

== Active Surveillance in Medicine ==

Active surveillance is a management strategy used in the medical field, particularly in the context of certain cancers and chronic conditions, where the disease is closely monitored through regular testing and clinical evaluations rather than immediate treatment. This approach is often employed when the condition is not causing any symptoms, is expected to progress slowly, or when the risks of treatment outweigh the potential benefits.

Historical Background

The concept of active surveillance emerged as a response to the overtreatment of certain cancers, particularly prostate cancer. Historically, many patients with low-risk prostate cancer underwent aggressive treatments such as surgery or radiation, which often resulted in significant side effects without substantial benefits in terms of survival. Over time, clinical evidence suggested that many of these cancers were indolent and unlikely to affect the patient's lifespan, leading to the development of active surveillance protocols.

Indications for Active Surveillance

Active surveillance is primarily indicated for:

• Prostate Cancer: Particularly in cases of low-risk, localized prostate cancer, where the tumor is small, confined to the prostate, and has a low Gleason score.
• Thyroid Cancer: Small papillary thyroid cancers that are not causing symptoms and are confined to the thyroid gland.
• Chronic Lymphocytic Leukemia (CLL): In early-stage CLL, where the disease is not causing symptoms or significant changes in blood counts.
• Renal Masses: Small renal masses that are suspected to be low-grade renal cell carcinoma.

Protocols and Monitoring

The active surveillance protocol typically involves:

• Regular Clinical Examinations: Patients are seen at regular intervals to assess any changes in symptoms or physical findings.
• Imaging Studies: Periodic imaging, such as MRI or ultrasound, to monitor the size and characteristics of the tumor.
• Biomarker Testing: Blood tests or other biomarker assessments to detect any biochemical changes that might indicate disease progression.
• Biopsies: Repeat biopsies may be performed to reassess the histological characteristics of the tumor.

The frequency and type of monitoring depend on the specific condition and the individual patient's risk factors.

Benefits of Active Surveillance

Active surveillance offers several advantages:

• Avoidance of Overtreatment: Patients avoid the side effects and complications associated with surgery, radiation, or chemotherapy.
• Quality of Life: By delaying or avoiding treatment, patients maintain a better quality of life.
• Cost-Effectiveness: Reduces healthcare costs associated with unnecessary treatments.

Risks and Challenges

While active surveillance is beneficial for many patients, it also presents challenges:

• Anxiety: Patients may experience anxiety knowing they have an untreated cancer.
• Risk of Progression: There is a risk that the disease may progress or become more aggressive, necessitating treatment.
• Compliance: Requires strict adherence to follow-up schedules, which can be burdensome for some patients.

Conclusion

Active surveillance is a valuable strategy in the management of certain low-risk cancers and chronic conditions. It allows patients to avoid the potential harms of overtreatment while ensuring that any progression of the disease is detected early. As research continues, the criteria and protocols for active surveillance are likely to evolve, further refining this approach to patient care.

References

• Tosoian, J. J., & Trock, B. J. (2016). Active surveillance for prostate cancer: Current evidence and contemporary state of practice. Nature Reviews Urology, 13(4), 205-215.
• Brito, J. P., & Morris, J. C. (2016). Active surveillance for thyroid cancer: A systematic review. Thyroid, 26(11), 1443-1450.
• Hallek, M. (2017). Chronic lymphocytic leukemia: 2017 update on diagnosis, risk stratification, and treatment. American Journal of Hematology, 92(9), 946-965.