II. Background

  1. Canadian protocol for Prostate Cancer active surveillance

III. Indications

  1. See Prostate Cancer Composite Risk for criteria
  2. Life Expectancy >15 years and
    1. See Charlson Comorbidity Index (Comorbidity-Adjusted Life Expectancy)
  3. Prostate Cancer Very Low Risk of progression
    1. PSA <10 ng/ml
    2. Gleason =6
    3. Stage T2a or less
    4. Prostate biopsy with <3 cores positive for cancer, less than 50% of cores involved, and PSA density <0.15

IV. Protocol: Surveillance

  1. PSA and Digital Rectal Exam
    1. Initial: Every 3 months for 2 years
    2. Later: Every 6 months
  2. Transrectal Ultrasound-guided biopsy with 10-12 core biopsies at one year and then every 3 years until age 80 years
  3. Consider transrectal Ultrasound on alternate exam dates

V. Protocol: Intervention indications

  1. PSA doubling time <3 years based on =8 values
  2. Gleason Score progresses to =7

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