Active surveillance

Last revised by Dr Joachim Feger on 11 Dec 2021

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)
  • 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:

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

See also

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