The most common eligibility criteria for this strategy are:
In recent cohorts, active surveillance has shown to be a viable approach for well-selected patients with a Gleason Grade 3+4 (ISUP 2). Eligibility for an active surveillance program must be discussed individually with a certified urologist. As a medium to long-term strategy, this management system involves monitoring cancer development with regular PSA testing, MRI, and biopsies. Active treatment can be initiated in the case of cancer progression or if the patient’s perceived risk/benefit ratio changes over time.
Watchful waiting is a management strategy similar to active surveillance. The main difference is that fewer or no follow-up diagnostic tests are performed in a watchful waiting program. Consequently, the side-effects linked to repeated biopsies are reduced if this procedure is removed from the monitoring plan.
Conversely, in the case of cancer progression, it may not be detected or may be detected less quickly than in an active surveillance program.
For this reason, watchful waiting is often recommended for patients whose life expectancy is < 10 years and who are at risk of dying from a cause other than prostate cancer, while preserving their quality of life by avoiding any treatment or diagnosis-related side-effects.
Another difference between watchful waiting and active surveillance is that watchful waiting can be offered to patients with higher-risk prostate cancer (intermediate or high), provided that the benefits/risk ratio related to life expectancy is preserved.
For over a decade, KOELIS® has developed 3D imaging technologies to better diagnose, visualize and monitor prostate cancer. Our latest platform, KOELIS Trinity®, integrates all of these technologies into an intelligent, intuitive, and efficient workflow that can benefit all patients at risk of prostate cancer.
The efficacy of an active surveillance program lies in the quality of the cancer stage monitoring. Namely, repeated follow-up biopsies at defined time intervals are the cornerstone of this strategy to track disease progression: if the Gleason score changes or if the size of the cancer measured on the biopsy cores progresses.
The standard practice for active surveillance biopsy is 12 systematic transrectally or transperineally guided cores in random areas of the prostate to identify the potential cancer foci (Figure 1).
Figure 1: Standard scheme for 12 cores systematic biopsy
The major drawbacks of this conventional approach are:
KOELIS Trinity® solves both of these issues while helping physicians choose the best management strategy for each patient:
Figure 2: 3D prostate map after a systematic biopsy exam, where 2 cores are positive for cancer (red)
Figure 3: 3D prostate map after a second biopsy examination: previous negative cores are in blue (purple if positive), newest negative cores are in green (red if positive)
Additionally, the 2nd Look technology can be combined with other KOELIS Trinity® technologies such as MRI/US fusion (see Figure 4). This is in line with recent active surveillance protocols where repeated MRI can be performed in-between the biopsy examinations.
Figure 4: 3D prostate map after a second biopsy examination with MRI targets: the pink target was recalled from a previous MRI, the most recent MRI shows an orange target. Targeted and systematic cores were performed during the first and most recent (2nd Look) exam
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