Prostate Cancer Active Surveillance The American Society of Clinical Oncology (ASCO) recommends Active Surveillance (AS) over immediate treatment for most patients with low-risk prostate cancer. The recommendation comes from a guideline published online Feb. 16 in the Journal of Clinical Oncology. ”It is increasingly clear that we recognize that active surveillance is an important treatment tool. For patients whose quality of life is barely likely to receive a progressive course of prostate cancer, it’s the overtreatment that is more painful.” Ronald C. Chen, PhD, has a master’s degree in public health from the North Carolina Comprehensive Cancer Center. Other institutional organizations have been recommending active surveillance for low-risk prostate cancer patients for some time. The National Comprehensive Cancer Network (NCCN) was the first organization to recommend the use of active surveillance for patients with low-risk prostate cancer, and their recommendation, published in 2010, concluded that active surveillance plays a pivotal role in the therapeutic management of patients with low-risk prostate cancer. Recently, the NCCN has extended this recommendation to include intermediate-risk prostate cancer, arguing that some patients with intermediate-risk prostate cancer can also be effectively managed with active surveillance. However, according to the JAMA study, only 12.1 percent of patients with low-risk prostate cancer would choose to have active surveillance from 2010 to 2011. According to Dr. Jain, an oncologist at Queen’s University Belfast in Northern Ireland, active surveillance is the preferred management strategy for the majority of patients with low-risk localized prostate cancer (Gleason score of 6 or less). However, patient heterogeneity still needs to be taken into account when making decisions. Age, Gleason score, ethnicity, and patient preference should all be taken into consideration. Younger patients younger than 55 years of age with large-volume Gleason score 6 prostate cancer need to be closely monitored for tumor trends and closely monitored for cancer progression. ASCO is not suggesting that physicians and patients should not undergo active surveillance in the presence of these conditions, but rather that clinicians and patients should be aware of the combined effects of various risks and take into account the heterogeneity of the individual patient before making final treatment strategies and clinical decisions. Active surveillance should include PSA testing every 3-6 months, rectal examinations (DRE) at least annually, and prostate biopsies if necessary. Clinical adjuvant radiation therapy and genetic testing can be performed when deemed necessary by the clinician, such as when abnormalities are found clinically or on pathologic biopsy. Patients with high-risk prostate cancer, i.e., those with a Gleason score of 7 or higher, should still be treated aggressively with treatment strategies such as radical prostatectomy. Also, ASCO does not specify conditions that are particularly applicable to active surveillance.