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Active Surveillance:  A Less Harmful Treatment Option for 
Patients with Low-Risk Prostate Cancer

The Association of Directors of Anatomic and Surgical Pathology is one of several organizations that participated in the development of recommendations for the role of pathologists in prostate cancer active surveillance, published August 5 by the College of American Pathologists in a special on-line posting of the Archives of Pathology & Laboratory Medicine. Active surveillance offers low-risk prostate cancer patients a means to avoid the potentially harmful side effects from treatment.  Pathologists help determine patient eligibility for active surveillance; the Archives posting is a set of recommendations for making such determinations.

With active surveillance, patients undergo regular visits with prostate-specific antigen (PSA) tests and repeated prostate biopsies rather than aggressive treatment. It is distinguished from watchful waiting, in which treatment for localized disease is withheld and palliative treatment for systemic disease is initiated.

“Active surveillance is an important management option for men with low-risk prostate cancer,” says lead author Mahul Amin, MD, FCAP, Chair, Department of Pathology & Laboratory Medicine, Cedars-Sinai Medical Center, Los Angeles, CA. “Vital to this process is the critical role pathologic parameters play in identifying appropriate candidates for active surveillance.”

Dr. Amin spearheaded the team that highlighted the pathologic parameters key for the successful identification of patients likely to succeed with active surveillance. The key parameters, at a general level, address:

  • Tumor extent in needle biopsies
  • Sampling, submission, and processing issues in needle biopsies used to diagnose prostate cancer
  • Biopsy reporting for all and special cases
  • Gleason scores, the system for grading prostate cancer tissue based on how it looks under a microscope
  • Precision medicine markers
  • Other pathologic considerations

The team further concluded that the key parameters to be reported by the surgical pathologists: (1) need to be reproducible and consistently reported and (2) highlight the importance of accurate pathology reporting.

Recommendations from the United States Preventive Services Task Force, an independent group of national experts in prevention and evidence-based medicine, and randomized trials have drawn attention to overtreatment of localized, low-risk prostate cancer. PSA screening and changing consensus on PSA testing practices are among the many factors that contribute to prostate cancer’s overdiagnosis and overtreatment.

The role of pathologists is outlined in the Archives article, entitled:  “The Critical Role of the Pathologist in Determining Eligibility for Active Surveillance as a Management Option in Patients With Prostate Cancer: Consensus Statement With Recommendations Supported by the College of American Pathologists, International Society of Urological Pathology, Association of Directors of Anatomic and Surgical Pathology, the New Zealand Society of Pathologists and the Prostate Cancer Foundation”