Rigi10™ Malleable Penile Prosthesis
Also Known As
Expectant management, watchful waiting (though this specifically refers to a less intensive monitoring approach), active monitoring, surveillance protocol, deferred treatment, observation protocol, expectant therapy, monitored observation
Definition
Active surveillance is a systematic approach to monitoring certain medical conditions, particularly low-risk cancers, without immediate intervention. It involves regular, scheduled medical evaluations and diagnostic tests to closely track a patient’s condition while delaying or potentially avoiding treatments that may cause significant side effects.1 This approach is characterized by a structured protocol of periodic assessments—including blood tests, imaging studies, and biopsies—conducted on a predetermined schedule to detect any changes that might indicate disease progression.2 Active surveillance may be used to avoid or delay the need for treatments such as radiation therapy or surgery, which can cause side effects or other problems.3 If test results show the condition is worsening or progressing beyond established thresholds, treatment options are then considered and implemented as necessary.4 Active surveillance is most commonly applied in prostate cancer management but is also utilized in other cancer types where the disease may be slow-growing and pose minimal immediate threat to the patient’s health and quality of life.5
Clinical Context
Active surveillance is primarily utilized in the management of low-risk and select favorable intermediate-risk prostate cancer.1 This approach is most appropriate for patients whose cancer is small, confined to one area of the prostate, has a low Gleason score (typically 6 or lower), and isn’t causing signs or symptoms.2 The clinical decision to recommend active surveillance involves careful consideration of multiple factors, including the patient’s age, overall health status, life expectancy, cancer characteristics, and personal preferences regarding quality of life and treatment side effects.3
The active surveillance protocol typically includes:
- Regular PSA (prostate-specific antigen) blood tests, usually every 3-6 months, to monitor for significant increases that might indicate cancer progression.4
- Digital rectal examinations (DRE) approximately once a year to physically assess the prostate for changes.4
- Prostate biopsies, typically performed within the first year of diagnosis and then every 1-3 years based on risk assessment and other test results.5
- Imaging tests such as multiparametric MRI, which is increasingly being incorporated into surveillance protocols to better visualize the prostate and detect significant changes.5
The primary clinical benefit of active surveillance is the avoidance or delay of treatment-related side effects, including urinary incontinence, erectile dysfunction, and bowel problems, which can significantly impact quality of life.1 Studies have shown that for appropriately selected patients, active surveillance results in excellent long-term cancer-specific survival, with the risk of prostate cancer metastasis ranging from 0.1–1.0% and the risk of prostate cancer mortality ranging from 0–1.9% at 10 years.1
Triggers for intervention and transition to active treatment typically include:
- Gleason score upgrade on subsequent biopsies
- Significant increase in tumor volume or extent
- Rapid PSA doubling time
- Development of symptoms
- Patient preference to pursue definitive treatment5
As active surveillance protocols continue to evolve, there is growing evidence supporting its use in select patients with favorable intermediate-risk disease, though this requires careful patient selection and counseling regarding the potentially higher risk of disease progression compared to those with low-risk disease.3