Potential for cancer to suddenly grow aggressively during active surveillance?

[p_jackson_33]

Active surveillance sounds ideal if you dont have an aggressive type of cancer, but one thing which has always bothered me (and has never been answered satisfactorily!) is the possibility that it could suddenly start growing quickly before you have time to catch it...is this possible? Are there any cases of this happening? Are PSA tests at 3/6 month intervals frequent enough?

[professoreden]

This is an excellent question. Active surveillance is now the default option for men diagnosed with low-risk prostate cancer (PSA less than 10, Gleason grade = 3+3 and a normal-feeling prostate or a nodule that can be felt on one side) and has increased hugely in popularity because it has no side-effects. However, and this is a big however, the tools that we use to monitor patients on active-surveillance (PSA blood tests every 3 months, a prostate MRI scan every year and repeat transperineal template prostate biopsy every 2 years) aren't perfect in picking up tumour progression in every case and it's important for men embarking on active surveillance to know this and accept the relatively small risk that their tumour could progress locally and/or spread despite close surveillance. Studies that have followed up men on active surveillance for a long time, such as that published by Dr Klotz from Sunnybrook Hospital in Toronto, Canada, confirm this low risk. They found that 2.8% of the 993 men followed for an average of 6.4 years developed metastasis (spread outside the prostate) and 1.5% died of prostate cancer.

[p_jackson_33]

...the relatively small risk that their tumour could progress locally and/or spread despite close surveillance. Studies that have followed up men on active surveillance for a long time, such as that published by Dr Klotz from Sunnybrook Hospital in Toronto, Canada, confirm this low risk. They found that 2.8% of the 993 men followed for an average of 6.4 years developed metastasis (spread outside the prostate) and 1.5% died of prostate cancer.

Ah ok - so it can happen then. The risk seems low, but perhaps not one worth taking for me - particularly if you get peace of mind and finality with other treatments. Thanks!