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Treatment Delay or Active Surveillance? A Matter of Perspective

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Way back in March—which can seem like a lifetime ago—we published this article about treatment delays. Since then, perhaps you have been able to make a plan with your doctor and are feeling a little better about the timeline. Others may be newly diagnosed and still uncertain about options that may—or may not—be available right now.

If you have low-risk or favorable intermediate-risk prostate cancer, another way to look at it may not be so much, “My treatment is delayed” as, “I’m starting Active Surveillance.”

Now, we know that men want to choose their treatment and not be thrust into Active Surveillance (AS) by default. But if the COVID-19 pandemic in your area makes it unsafe or unrealistic for you to begin radiation therapy or be scheduled for surgery now, even though you didn’t plan it this way, AS may be a very reasonable path.

Check out this video to hear one man’s story of how AS turned out to be the best choice for him. Consumer advocate and PCF Board Member Clark Howard describes how regular monitoring has been a part of his life for 12 years—along with dietary changes and exercise. A side benefit? At age 64, thanks to yoga, he’s able to get out of bed in the morning with no nagging aches or pains!

What is AS? AS is based on data that low-risk prostate cancer has not been shown to cause harm or decrease life expectancy. In fact, it has emerged as the preferred standard of care. Over 30% of men have prostate cancers that are so slow-growing that AS is a better choice than immediate treatment because it allows them to avoid side effects from treating disease that will never cause them harm.

What happens on AS? Men will usually have a PSA blood test done once or twice per year and a Digital Rectal Exam (DRE) annually, with repeat biopsies every 1 to 5 years. MRI is also being incorporated. If or when test results indicate that your cancer has begun to progress, treatment such as surgery or radiation may be warranted, and in a large majority of cases will still be curative.

If you are already on AS now, your usual schedule may be temporarily delayed. Providers around the country are finding ways to follow up with patients via telemedicine—for example, having blood drawn for a PSA check at an outside lab close to their home and then scheduling a call to discuss the results.

Is AS right for all men? No. If you have high-risk prostate cancer, you may need to make a plan for curative treatment. Talk to your doctor about your specific case. But if you and your doctor decide that AS is an option, know that this is highly recommended for thousands of men each year with low-risk disease. For more information, download our Prostate Cancer Patient Guide.

Becky Campbell
Becky Campbell develops medical content at the Prostate Cancer Foundation. She has previously worked in outcomes research and in science education.