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Active surveillance (observation)

Active surveillance is used in some cases of low-risk disease, as well as among older patients for whom active treatment with surgery or radiation therapy may not be possible or necessary. Active surveillance is most often used because some prostate cancers may never become life-threatening. PSA and digital rectal exams, or DRE, are typically checked periodically, and current active surveillance protocols recommend repeat biopsies to ensure that disease does not progress.

Interstitial prostate brachytherpay involves placement of small radioactive pellets, or “seeds” into the prostate. In general, this treatment can be used for small to normal sized prostates and for Gleason Grade 6 or less tumors. In settings of higher-risk disease (PSA>10 ng/mL or Gleason Grade 7) where there is concern for extraprostatic extension, external radiation therapy should be used in conjunction with interstitial bracytherapy to ensure adequate cancer control. In some cases, hormone therapy may be used before brachytherapy to help reduce the size of the prostate.

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