Who Should Choose Active Surveillance?
Active surveillance may be right for you if your cancer is in grade group 1 (Gleason 3+3), PSA <10, and the cancer is confined to the prostate and/or cancer that is very low volume when biopsied (download the Prostate Cancer Patient Guide for a full comparison of risk groups). Selected cases with low-volume grade group 2 (Gleason 3+4) tumors may also be considered for active surveillance. Sometimes commercial tests—such as Decipher®, Oncotype DX GPS®, and Prolaris®—can be used to help guide decisions about active surveillance in situations that are less clear. These tests are currently covered by Medicare and (less often) by private insurance companies, so check with your insurance provider to confirm if you are covered if your doctor recommends this test. It is always a good idea to talk with your doctor about your choices, and see if active surveillance might be right for you.
Often men wonder if they are the “right” age for active surveillance. There is no right answer to this question. The ideal candidate for active surveillance has low-risk prostate cancer.
For younger men who have the potential to live for quite a long time after diagnosis, it is important to think about preserving quality of life while making sure to identify high-risk prostate cancer if it develops. A man with a less aggressive form of cancer may be able to stay on active surveillance for many years, thus delaying side effects such as urinary incontinence, erectile dysfunction and others.
For men who might have a shorter life expectancy, either because of older age or because of other medical problems, active surveillance may actually be too aggressive. For these men, watchful waiting may be more appropriate. Watchful waiting is a more passive strategy which avoids repeat biopsies and leads to non-curative or palliative treatments only if the cancer starts to cause symptoms. A man who is currently battling other serious disorders or diseases—such as very advanced heart disease or other cancers—should consult with his doctor about whether watchful waiting would help him avoid unnecessary treatment and would be recommended.
For everyone else, as with any treatment for prostate cancer, shared decision-making with a physician is necessary, and maintaining a healthy lifestyle is advised to maximize results.
This blog is an excerpt of the Prostate Cancer Patient Guide. To download the full guide click here.