Dr. Chapin on Choosing Active Surveillance for Patients With Prostate Cancer

Brian F. Chapin, MD, assistant professor, Department of Urology, Division of Surgery, The University of Texas MD Anderson Cancer Center, discusses the considering factors for a patient with prostate cancer to undergo active surveillance versus active treatment.

The ways physicians risk stratify patients into the low-risk category is mainly by Gleason scoring, Chapin explains. This is a pathologic assessment of the tumor, and we identify Gleason score 6—which is grade 3 + 3 tumors—as being low risk and having low metastatic potential.

Additional factors such as prostate-specific antigen and digital rectal exam are used to categorize patients in the low-risk group. Physicians at The University of Texas MD Anderson Cancer Center, Chapin adds, use a protocol-based program that involves a confirmatory biopsy within 6 months of the original biopsy, and planned assessments every 6 months with a digital rectal exam and PSA test.

Every 1 to 2 years, a repeat biopsy and/or MRI-scan imaging is done to better assess the patient’s situation and make changes as the disease evolves.