II. Background
- Canadian protocol for Prostate Cancer active surveillance
- Avoids the risk of urinary, sexual and bowel dysfunction with Prostate Cancer Management
- Low risk Prostate Cancer mortality is 2.4% over 10 years
- Active surveillance mortality in low risk Prostate Cancer is as low as 0.8% over 10 years
III. Indications
- See Prostate Cancer Composite Risk for criteria
- Life Expectancy >15 years and
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Prostate Cancer Very Low Risk of progression
- PSA <10 ng/ml
- Gleason =6
- Stage T2a or less
- Prostate biopsy with <3 cores positive for cancer, less than 50% of cores involved, and PSA density <0.15
IV. Protocol: Surveillance
- PSA and Digital Rectal Exam
- Initial: Every 3 months for 2 years
- Later: Every 6 months
- Transrectal Ultrasound-guided biopsy with 10-12 core biopsies at one year and then every 3 years until age 80 years
- Consider transrectal Ultrasound on alternate exam dates
V. Protocol: Intervention indications
- PSA doubling time <3 years based on =8 values
- Gleason Score progresses to =7