Active surveillance

Last revised by Joachim Feger on 11 Dec 2021

Citation, DOI, disclosures and article data

Citation:

Feger J, Bell D, Foster T, Active surveillance. Reference article, Radiopaedia.org (Accessed on 20 Apr 2024) https://doi.org/10.53347/rID-84494

DOI:

https://doi.org/10.53347/rID-84494

Permalink:

https://radiopaedia.org/articles/84494

rID:

84494

Article created:

26 Nov 2020, Joachim Feger ◉

Disclosures:

At the time the article was created Joachim Feger had no recorded disclosures.

View Joachim Feger's current disclosures

Last revised:

11 Dec 2021, Joachim Feger ◉

Disclosures:

At the time the article was last revised Joachim Feger had no recorded disclosures.

View Joachim Feger's current disclosures

Revisions:

6 times, by 3 contributors - see full revision history and disclosures

Systems:

Urogenital, Oncology

Tags:

management, cases

Active surveillance describes a management option aiming at close monitoring of a specific stage in disease and minimizing adverse treatment-related effects without compromising survival at the same time. Curative or definite treatment is intended and offered upon deterioration or explicit patient request.

Usage

Active surveillance is implemented in diseases with slow progression or low-risk patients not requiring immediate treatment and in which early curative treatment is associated with a lower quality of life and similar outcome as compared to no treatment. Follow-up is conducted according to a predefined schedule.

Active surveillance is an accepted management option in the following diseases:

Prostate cancer

Indications

Active surveillance is indicated under the following conditions ^1-4:

low-risk prostate cancer (clinically insignificant prostate cancer)
- Gleason-Score: ≤6 (3+3)
- maximum number of positive biopsy samples ≤2
- tumor volume within the positive biopsy sample ≤50%
- tumor stage cT1-cT2a
- prostate specific antigen (PSA) 10 ng/mL / PSAD ≤0.15 ng/mL²
intermediate-risk prostate cancer
- Gleason Score: ≤7a (3+4)
- in patients >70 years and/or who choose not to have immediate radical therapy

Protocol

Recommendations as per NICE guidelines 2019 ²:

monitoring of PSA/PSAD and PSA velocity (every 3-4 months within the 1^st year, every 6 months thereafter)
digital rectal examination (DRE) (every 12 months)
multiparametric MRI of the prostate (at 12 to 18 months)
clinical changes or PSA changes should prompt reassessment with mpMRI and/or repeat biopsy

Renal cancer

Indications

Active surveillance can be considered under the following conditions ^5-7:

in patients of advanced age with medical comorbidities and
small renal masses suspicious for cT1a renal cell carcinoma (RCC) <2 cm size

Protocol

Recommendations as per ²:

imaging follow up (every 6 months for 2 years and yearly thereafter)
quality of life assessment (at 6 months and 1 year and yearly thereafter)
chest imaging (annually)
progression (size <4 cm or growth 0.5 cm/year) should prompt intervention and standard of care