Active Surveillance
Professor Declan Murphy has had a long-standing interest in active surveillance and has published many papers on this topic. He has documented a significant rise in rates of active surveillance around Australia and around the world, and looks after very many men on active surveillance in his practices at Cancer Specialists and Peter MacCallum Cancer Centre.
Active surveillance is our preferred management option for many men with prostate cancer
This is particularly so for those with low-grade cancers, at low risk of progressing beyond the prostate. The key principle of active surveillance is that if men with suitable prostate cancer are managed with surveillance rather than treatment, that the likelihood of their cancer becoming more aggressive and progressing beyond the prostate, is very low indeed. Also, if the cancer does become more aggressive while on surveillance, subsequent treatment such as surgery or radiotherapy is very successful. Therefore, the twin goals of successful cancer treatment, while avoiding side-effects, can be balanced.
The NAVIGATE study
Declan is an investigator on the NAVIGATE study, a study of an online decision aid for men with localised prostate cancer who are considering active surveillance to manage their cancer. Currently recruiting at Cancer Specialists, Peter Mac and other centres around Australia.
FAQs
Is my cancer suitable for active surveillance?
There are specific guidelines to help identify which men are suitable for active surveillance. Typically, men are in good health with good life expectancy, with relatively low PSA levels (less than 10ng/mL), favourable MRI findings, and favourable biopsy findings (grade group 1; Gleason 3+3=6). Overall, about 60-70% of patients with low-risk prostate cancer in Australia are managed with active surveillance.
What does surveillance involve?
In the first year after diagnosis, PSA tests are obtained every 4-6 months, and a further MRI scan and prostate biopsy are obtained 12-18 months after initial diagnosis, to ensure that the cancer remains suitable for surveillance. Subsequently, PSA tests are usually obtained every 6 months, and further MRI scans and biopsies every 2-3 years.
What is the likelihood of me switching over to treatment instead of continuing surveillance?
We have reported that in men on active surveillance in Victoria, about 17% will switch from surveillance to treatment at the one year check-up. This is consistent with active surveillance around the rest of the world. Overall, at five years following diagnosis, about 30% of patients will switch from surveillance to treatment due to a change in the nature of their cancer.
Can I have an MRI scan instead of a prostate biopsy?
Prostate MRI scanning is a key part of our active surveillance program. However, MRI is not as definitive as a prostate biopsy, therefore prostate biopsies are still recommended from time to time.
Are there any clinical trials ongoing?
Yes, Declan is an investigator on the NAVIGATE study, based at Peter MacCallum Cancer Centre. We understand that it can be difficult for patients and their loved ones to make a decision about how to manage their early prostate cancer. NAVIGATE is an NHMRC-funded online decision aid to help patients in these situations.