Active surveillance in prostate cancer: a concept analysis

Aim To report an analysis of the concept of active surveillance. Background Prostate cancer has become more prevalent since the introduction of PSA screening, however, many men are diagnosed with low‐risk disease that may not require treatment. Active surveillance is a treatment strategy used to avoid treatment and related adverse effects when immediate treatment is not necessary. A universal definition is lacking. Design Concept analysis. Data sources The CINAHL, PubMed, Scopus, Cochrane Library and Google Scholar databases were searched for literature published between 1980 and 2014 using the term active surveillance. Methods The method of Walker and Avant (2010) was used to analyse the concept of active surveillance, specifically within the context of prostate cancer. Results Key attributes of active surveillance emerging from the analysis include: regular and purposeful monitoring, early detection of disease progression and planned curative intervention if necessary. Multiple terms are used in the literature to refer to the concept of active surveillance. Active surveillance can cause uncertainty, and prompt men to make lifestyle changes and seek more information on prostate cancer. Conclusion Active surveillance is not well understood, and ambiguity remains around the concept. Active surveillance and watchful waiting are used interchangeably in the literature and in clinical practice, but in fact do not refer to the same strategy. Active surveillance can generate significant uncertainty for the patient and family, which may be a barrier to choosing it as a treatment strategy and nursing research in this area is limited. Relevance to clinical practice Nurses need a clear understanding of active surveillance and how it differs from other strategies in order to reduce ambiguity around the concept. Nurses must be aware of the uncertainty accompanying active surveillance, and a need exists for continued nursing research in this area.