Active Holistic Surveillance: The Nutritional Aspect of Delayed Intervention in Prostate Cancer

Abstract

Purpose. Active surveillance is an emergent strategy for management of indolent prostate cancer. Our institution's watchful waiting protocol, Active Holistic Surveillance (AHS), implements close monitoring for disease progression along with various chemopreventive agents and attempts to reduce unnecessary biopsies. Our objective is to report on the treatment rates of men on our AHS protocol as well as determine reasons for progression. Materials/Methods. Low risk and low-intermediate risk patients were enrolled in AHS at Winthrop University Hospital between February 2002 and August 2015. Our IRB-approved study analyzed survival rate, discontinuation rates, and definitive treatments for patients in our AHS cohort. Results. 235 patients met inclusion criteria. Median age and follow-up for the cohort were 66 (44–88) years and 42 (3–166) months, respectively. The overall survival for the cohort was 99.6% and the disease specific survival was 100%. A total of 27 (11.5%) patients discontinued AHS. Conclusion. The incorporation of chemopreventive agents in our AHS protocol has allowed patients to prolong definitive treatment for many years. Longer follow-up and additional studies are necessary to further validate the effectiveness of AHS.

Active Surveillance of Prostate Cancer Using Multiparametric Magnetic Resonance Imaging: A Review of the Current Role and Future Perspectives

“…Active surveillance may help to resolve the problem of overtreatment of low-risk prostate cancer. Also, the implementation of multiparametric MRI can reduce the number of prostate biopsies and refine the early identification of occult higher-risk disease as well as reduce the number of diagnostic biopsies in low-risk patients with lesions in the anterior prostate [2]. The selection of candidates for active surveillance and disease re-classification during active surveillance using imaging of the prostate gland would be beneficial and increase diagnostic accuracy and improve patient management.…”

Contemporary approach to active surveillance for favorable risk prostate cancer

“…All surveillance patients should have a confirmatory biopsy targeting the anterolateral horn and anterior prostate within 6–12 months. Subsequent biopsies should be done at 3–5-year intervals; these may be avoided if MP-MRI is negative in low-risk patients [60] .…”

Effects of Focal vs Total Cryotherapy and Minimum Tumor Temperature on Patient-reported Quality of Life Compared With Active Surveillance in Patients With Prostate Cancer

“…Robust evidence of oncological outcomes of focal therapy is lacking 3,20 . Therefore, we analyzed the QoL in focal (hemiablation) cryotherapy patients, and how it compares to that in patients who underwent total cryotherapy or active surveillance (AS) 21 . We investigated two modifiable parameters of cryotherapy: minimum tumor temperature and extent of cryoablation (focal and total gland ablation) to determine their association with post-procedural QoL (urinary, bowel, and sexual function) in prostate cancer patients.…”