Treating Prostate Cancer By Close Monitoring or ActiveSurveillance

Prostate cancer is the most common cancer in older men and second most common cause of death due to cancer in men over the age of 50.  This year more than 180,000 men will be diagnosed with prostate cancer and more than 30,000 men will die of this disease.  There are multiple treatment options for prostate cancer including surgery, radiation, hormone therapy and now there’s a new option: watchful waiting or active surveillance.  Active surveillance means no treatment but careful monitoring with regular digital rectal exams, PSA testing, and possible other tests and\or imaging studies.  This blog is intended to help men who have received a diagnosis of prostate cancer to help guide them in the decision of active surveillance or more aggressive standard treatment options.

What you need to know

The prostate gland is a walnut-sized organ at the base the bladder and surrounds the urethra or the tube in the penis that transports urine from the bladder to the outside of the body.  The prostate gland’s function is to make the fluid that mixes with the sperm and provides the sperm with nourishment to help fertilize an egg and start the process of conception.

For the first part of a man’s life the prostate gland provides pleasure and enjoyment.  After age 50 for reasons not entirely known, the prostate gland starts to grow and compresses the tube or the urethra and produces difficulty with urination.  Again, for reasons not entirely known the prostate cells grow uncontrollably and this results in prostate cancer.

Prostate cancer is a very common as one in seven American men will develop prostate cancer.

There are two tests used to detect prostate cancer: 1) the digital rectal exam and 2) the PSA or prostate specific antigen test.  PSA is a protein made by the prostate gland.  An increased level of PSA can be a sign of prostate cancer but an elevation is also seen in men with prostate gland infections and benign enlargement of the prostate gland.

Active surveillance is now considered an acceptable management option in certain men with prostate cancer.  Active surveillance is a type of close follow up. In addition to the PSA and digital rectal exam, a repeat biopsy may be indicated.  A biopsy test called a fusion-guided biopsy is one of these newer tests that combines the MRI with real-time ultrasound images of the prostate.  Genomic tests are another development for prostate cancer assessment.  These tests look at the DNA of the cancer to decide if the cancer is stable or growing.  If any of these tests indicate that the cancer is growing, you may require additional treatment.

At the present time there is no universal agreement about how often the tests should be done for men who are participating in active surveillance.  Patients who are at low risk, that is have a low PSA and a biopsy that reveals a reasonably favorable pathology report, then he can have his PSA check every six months.  It is also common to have a repeat biopsy 12-18 months after the diagnosis.

Candidates for Active Surveillance

Men with early stage prostate cancer that is confined to the prostate gland are the best candidates for active surveillance.  Also, good candidates are men without symptoms and have prostate cancer that is slow growing.  Finally, older men with serious other medical problems which may interfere with treatment are potential active surveillance candidates.

The benefits of active surveillance is that it is low cost, safe, and has no side effects.  Men are able to maintain day-to-day quality of life and not have any of the complications of treatment such as impotence\ED or urinary incontinence.  The risk is that men can become complement and not follow up as often as they should and that the cancer can grow and become more aggressive.

Bottom Line:  Prostate cancer is a common problem in middle age and older men.  Most men if they live long enough will develop prostate cancer.  However, most men with the diagnosis of prostate cancer will die with the cancer and not from it.  My best advice is to have a conversation with your doctor and see if active surveillance is right for you and your cancer.

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