Active surveillance

Active Surveillance

Active surveillance is a management strategy used in the medical field, particularly in the context of certain cancers and other chronic conditions, where the disease is closely monitored through regular check-ups and tests, but treatment is delayed until there are signs of progression. This approach is often chosen to avoid or postpone the side effects of treatments such as surgery, radiation, or chemotherapy.

Overview

Active surveillance is primarily used for conditions where the disease is known to progress slowly, and immediate treatment may not be necessary. The goal is to maintain the patient's quality of life by avoiding unnecessary treatments while still keeping the disease under control.

Conditions Managed by Active Surveillance

Active surveillance is commonly used in the management of:

• Prostate cancer: Particularly in cases of low-risk, localized prostate cancer, where the cancer is not causing symptoms and is expected to grow slowly.
• Chronic lymphocytic leukemia (CLL): A type of cancer that often progresses slowly and may not require immediate treatment.
• Renal cell carcinoma: Small kidney tumors that are not causing symptoms may be monitored rather than treated immediately.

Monitoring Protocol

Patients under active surveillance typically undergo regular monitoring, which may include:

• PSA test: For prostate cancer, regular prostate-specific antigen (PSA) tests are conducted.
• Imaging studies: Such as MRI or CT scans to monitor tumor size and progression.
• Biopsy: Periodic biopsies may be performed to assess the aggressiveness of the cancer.

Criteria for Intervention

Treatment is initiated if there are signs of disease progression, such as:

• Increase in tumor size or PSA levels.
• Development of symptoms.
• Changes in biopsy results indicating more aggressive disease.

Benefits and Risks

Benefits

• Avoidance of treatment side effects: By delaying treatment, patients can avoid the side effects associated with surgery, radiation, or chemotherapy.
• Maintenance of quality of life: Patients can continue their daily activities without the burden of treatment-related complications.

Risks

• Anxiety: Some patients may experience anxiety knowing they have an untreated cancer.
• Risk of progression: There is a risk that the disease may progress more rapidly than expected, potentially reducing the effectiveness of later treatments.

Also see

• Watchful waiting
• Prostate cancer management
• Cancer staging
• Biomarkers in cancer

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