The concept of active surveillance, or watchful waiting, has emerged in recent years as an excellent option for men who decide not to undergo immediate surgery or radiation therapy. Of the top four cancers, lung, prostate, breast, and colon, only prostate cancer has an early form that is called “low grade” or “indolent”, that does not need surgery or radiation.
During active surveillance, prostate cancer is carefully monitored for signs of progression. Some patients can develop a second, more aggressive prostate cancer, and this must be watched over time. A PSA blood test and digital rectal exam (DRE) are usually administered periodically along with a repeat biopsy of the prostate at one year and then at specific intervals thereafter. If symptoms develop, or if tests indicate the cancer is growing, treatment might be warranted.
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When to Choose Active Surveillance
Current estimates indicate that 30% more men are aggressively treated for prostate cancer than is necessary to save a life from the disease. The challenge has been to identify those men who do not need immediate therapy, which is usually decided based on age, other medical conditions, and cancer factors like the PSA, stage, amount of cancer in the biopsy, and Gleason grade. Research is ongoing to develop biomarkers and additional tests that can better risk stratify men so that this decision is easier and more accurately informed.
Today, the man who is ideal for active surveillance has a low grade (Gleason 6 or under), low-risk prostate cancer (low PSA and stage), that appears to be low in volume (small amount of cancer found on biopsy, for example). There are also patients not eager to undergo therapy right away due to concerns about potency preservation or urinary symptoms.
Active surveillance can be a good choice for older men with limited life expectancy. In addition, if a man is currently battling other serious disorders or diseases, such as heart disease, long-standing high blood pressure, or poorly controlled diabetes, his doctors might feel it is in his best interest to hold off on therapy and avoid its potential complications.
The right age for active surveillance is a difficult question, as clearly younger men will live longer with their cancers, and thus have a higher likelihood that their cancer could progress. This decision is best made with your doctors on an individual basis. Ongoing clinical trials will provide more guidance for this in the future. In any case, you should be followed closely over time by your urologist to make sure that if your cancer does progress, it will still be caught early enough to be cured with radiation or surgery.
Terms to know from this article:
The grade of a tumor depends on how abnormal the cancer cells look under a microscope and how quickly the tumor is likely to grow and spread. Grading systems are different for each type of cancer.
prostate-specific antigen (PSA): A substance produced by the prostate that may be found in an increased amount in the blood of men who have prostate cancer, benign prostatic hyperplasia, or infection or inflammation of the prostate.
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