The expanding role of active surveillance in urology


It is fascinating to see that, as urologists have begun to understand and accept the viability and value of active surveillance (“expectant management”) in management of prostate cancer, they are beginning to see other uses for this strategy too.

In a newly published article in Urology Practice, Gorin and Soloway have now laid out the rationale and justifications for the application of active surveillance in the management of apparently low-grade, papillary bladder cancers (only about 5 to 10 percent of which will progress in stage or grade over time). The link above gives access to the full text of their article for readers who are interested. What is important here is that about half of all the new cases of bladder cancer diagnosed each year are apparently low-grade, papillary cancers, so, as with prostate cancer, there is enormous potential for over-treatment of a relatively benign form of cancer.

As long ago as 2011, Jewett et al. had also shown that active surveillance was a perfectly reasonable strategy for the management of many early-stage forms of kidney cancer (renal cell carcinomas diagnosed incidentally by imaging as small renal masses).

We believe that this is important information for prostate cancer support group leaders and other prostate cancer educators because it helps patient to understand that active surveillance as a management strategy is by no means unique to prostate cancer, but may actually be applicable across many forms of cancer.

In the case of the blood cancer called myeloma, for example, one of the precursor forms of the disease is defined and referred to as monoclonal gammopathy of undetermined significance” or “MGUS.” Even back when this condition was initially described and defined (many years ago now), it was acknowledged by a small group of myeloma specialists that it should be monitored and not treated because such a small percentage of the patients exhibiting the characteristics of MGUS actually went on to develop a clinically evident form of myeloma. We know now that patients diagnosed with MGUS have a probability of only 1 percent per year of progressing to multiple myeloma or another form of blood cancer known as lymphoma, so with regular monitoring one can almost invariably identify these patients early enough toi begin treatment when it is needed as opposed to treating them too early.

3 Responses

  1. I am not sure if this is an appropriate forum and I apologize if it is not. I am looking for input from prostate cancer patients in regards to their access to and understanding of their actual pathology report(s). I am not asking for any personal information, just opinions. If interested, please follow this link.

    Thanks to anyone who responds.

  2. Boy, you hit it on the head with that word “fascinating” when describing active surveillance and urologists. I would have included the word “oxymoron” to the conversation too, since we still have prostate cancer patients being prescribed radiation/surgery instead of a more rational approach.

  3. For anyone who has followed my link above and not been able to leave a comment, please try again with the following link. Thanks for your input.

    https://prostatereport.wordpress.com/2015/08/28/prostatereport-an-interpretive-prostate-pathology-reports/

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