If the doctor has found a low risk profile for your prostate cancer, treatment does not necessarily have to be immediate. For slow or non-growing prostate carcinomas, Active Surveillance offers a further option, namely "non-treatment". Here, no therapy is initially carried out, but it is waited to see whether the tumour will grow. However, this is by no means "passive waiting" or "doing nothing". If the patient opts for Active Surveillance, this is associated with regular check-ups.
If there are initial signs that the disease is progressing, appropriate therapeutic measures are taken. The aim is to achieve a good quality of life with Active Surveillance and at the same time to leave the possibility of therapy open at a later point in time.
Criteria for Active Surveillance
Patients in whom no clinically relevant tumour growth is to be expected due to the favourable development and composition of the tumour or due to their age may be considered. The inclusion criteria for active monitoring are very strict. According to the current guidelines, the following parameters apply:
PSA value ≤ 10 ng/ml;
Tumor volume ≤ 1.3 ml
Gleason Score ≤ 6
Stage: cT1 and cT2a;
Tumour in ≤ 2 punches with 10-12 punches removed
≤ 50 % Tumor per punch
Active Surveillance procedure
During the first two years, the tumour is actively monitored every three months by means of PSA, palpation and imaging, and every 12 months by renewed prostate biopsy. If the PSA level remains stable, the examination period is extended to six months. If the control biopsies show no change in the tumour in the first three years, tissue samples are taken only every three years.
If the PSA level rises during the period of active monitoring, this does not automatically mean that therapy must be started immediately if the increase is very slow. Only when the PSA level has doubled in less than three years or the control biopsy indicates a progression of the tumour does a new treatment strategy have to be chosen together with the patient.