As the second leading cause of cancer death in men, prostate cancer needs to be taken seriously. Each year in the U.S., there are more than 230,000 new cases diagnosed and 30,000 deaths. However, prostate cancer may never need to be treated. Shocking, right?
Prostate cancer is a cancer that does not always need to be cut, radiated, or treated with chemicals. Patients with slow-growing, early stage prostate cancer and older men with other health issues may be put on active surveillance, also known as watchful waiting, as opposed to traditional treatments.
The challenge is predicting the future behavior of the prostate cancer so it can be treated appropriately. If the future behavior could be predicted, a cure could be offered to those with aggressive cancer, and active surveillance could be pursued in those who have non-aggressive cancer. The goal of active surveillance is to allow men with low risk prostate cancer to avoid radical treatments with their associated side effects and delay treatment until signs of progression occur. This involves vigilant monitoring and a compliant patient who is attentive to follow-up.
Being a candidate for this approach is based upon findings on the digital rectal exam of the prostate, the results of the PSA blood test and the details of the biopsy, which usually involves obtaining at least a dozen samples of prostate tissue. Active surveillance is appropriate with a rectal exam of the prostate that is normal or reveals an abnormality on only one side of the prostate, a PSA less than 10, a relatively benign appearance under the microscope (Gleason grading system--score 6 or less), just a few biopsies showing cancer (3 or less), and less than half of any involved core showing cancer.
Active surveillance does not mean doing nothing. It is a structured means of careful follow-up with rigorous monitoring and intervention, should signs of worsening of the cancer develop. The active surveillance monitoring schedule is typically a prostate exam and PSA blood test every 3-6 months for several years, then annually and a repeat prostate biopsy periodically. As long as the cancer remains low-risk, the surveillance can be continued.
Its disadvantages are the need for frequent and repeated testing and biopsy, the anxiety of living with untreated prostate cancer, and the possibility that delayed treatment might not be curative, although that is a rare occurrence.
A change in plan from active surveillance to active treatment needs to be considered if the results of the prostate exam or PSA blood test worsen or if the repeat biopsy shows a progression to a higher grade or increased cancer volume. The absence of cancer on repeated prostate biopsy (because the cancer is of such low volume) identifies men who are unlikely to have progressive prostate cancer. About one half of men on active surveillance remain free of progression 10 years after diagnosis, and definitive treatment is most often effective in those with progression.
Active surveillance is an effective means of minimizing over-treatment of low-risk prostate cancer and avoiding the side effects of treatment. You can find more information about prostate cancer at the following sites:
Andrew Siegel, M.D., Urologist, Cofounder of The Private Gym, and author of the highly acclaimed book, Male Pelvic Fitness, Optimizing Your Sexual and Urinary Health.
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