ProActive Surveillance (PAS)

Definition of a new third stage in the prostate cancer process.
Written by Howard Wolinsky – Chicago – February 2018

The organizers of Active surveillance conference in Iceland in October 2019—the first international patient-driven meeting of patients with early-stage prostate cancer—are introducing a new approach to tackling early-stage prostate cancer. We call this approach ProActive Surveillance.

You have heard of active surveillance and watchful waiting, terms used for approaches to follow early-stage prostate cancer rather than rushing in with aggressive, potentially risky and life-changing therapies such as surgery and radiation. Doctors still debate the value of these terms and others, such as observation and expectant management. 

Whatever you call it, two-thirds of men diagnosed with early-stage prostate cancer will never need those therapies. They can live with their cancer and will die from another cause. The problem is doctors can’t precisely predict who will need definitive treatment and who won’t. Hence, the need for patients to be followed with prostate-specific antigen (PSA) tests, digital rectal exams, multi-parameter MRI scans and biopsies.

We—all prostate cancer patients or their advocates—are recommending a new approach, what we call ProActive Surveillance, taking our care beyond what has been done with traditional active surveillance or watchful waiting.  Why ProActive?  “Proactive” means you make things happen, instead of waiting for them to happen to you., according to Active means "doing something." The prefix pro- means "before." So, if you are proactive, you are ready before something happens. It’s the opposite of reactive or waiting for things to happen before responding.

We are proactive patients. We and our life partners are deeply involved in our care. We consult not only with our doctors, but our fellow patients to learn what has worked for them. We follow the latest developments in the medical literature and the medical news that impacts us. We discuss everything with our family doctors, oncologists and urologists. We consult with dietitians and urologic naturopaths, discussing how the right food and dietary supplements can improve not only our prostate health but our health overall. We consult with exercise physiologists and alternative healers. We search for answers to control our disease.  We need to discuss what proactive patients do when surveillance is no longer possible if their disease is becoming more aggressive and may be spreading to other organs.

We urge you to join us in Active surveillance to share your experiences and hear about ours as proactive patients. We will get to know each other and form new networks as we develop this new concept of ProActive Surveillance.