Some men with early-stage prostate cancer are sometimes better off
monitoring and managing the condition versus invasive surgery. New
studies show that surgery offers no discernable benefit for men with
slow-moving and early-stage prostate cancer.
In recent years, doctors are increasingly reliant upon prostate-specific
antigen (PSA) screenings to diagnose prostate cancer. Cancer isn’t the
only thing that can cause a higher-than-normal PSA level,
however—increased numbers may also be caused by infection, inflammation, and enlargement of the prostate.
As more doctors have begun using the PSA tests as a screening tool for
prostate cancer, more men are finding out they have prostate cancer.
That’s a double-edged sword, however: The PSA test helps find and
diagnose prostate cancer before it can become advanced and cause serious
health problems, but some prostate cancers that would have otherwise
never caused a problem are being detected, too.
When a high PSA test comes back, many of these men opt for invasive radical prostatectomy, chemotherapy, or radiation. These treatments can
cause serious side effects like urinary incontinence and sexual
impotence. In other words, treating the prostate cancer may cause more
harm than the cancer would cause, even if it were left untreated.
Active Surveillance
More than half of all prostate cancers diagnosed today are low-risk.
These slow-growing, non-aggressive tumors are not causing symptoms in
the men who have them, and they’re most often only detected because of
elevated PSA levels. Studies that have followed men who were diagnosed
with these low-risk cancers show that only five percent of these men
actually end up developing aggressive prostate cancer and dying from it.
Active surveillance refers to a form of disease management in which
patients with early-stage prostate cancer opt to not treat their cancer
but instead monitor their cancer closely for changes. Older men or those
with other serious health problems may never need to treat their
prostate cancer. If it is very slow growing, the cancer is likely to
never cause problems or hamper quality of life in later days.
This approach may allow men to avoid radical treatments and the side
effects that often accompany them. If you decide to use active
surveillance, your doctor will likely require you to undergo regular PSA
screenings, DREs, and ultrasounds to check for changes. You may also
need occasional prostate biopsies.
Watchful Waiting
Some men may decide to not monitor their prostate cancer as closely,
forgoing the regular PSA tests and DREs. This type of approach relies on
changing signs and symptoms to let a man know when his prostate cancer
is changing or growing.
What Are the Risks?
With active surveillance, you’re likely to catch changes pretty quickly
because of the elevated amounts of monitoring and testing that are
central to this approach. However, watchful waiting may carry more
risks. As a person using watchful waiting is not keeping close tabs on
the chemical and physical changes of their body, they are less likely to
catch advancing prostate cancer if it changes between check-ups.
How to Talk to Your Doctor
Active surveillance and watchful waiting are not right for every person
with prostate cancer. These treatments are most likely to be recommend
to patients in the following scenarios:
- if the prostate cancer is not causing any symptoms
- if the cancer is slow growing and isn’t expected to grow rapidly
- if the cancer is still contained within the prostate
- if you are older and have additional health problems that might be complicated by or interfere with prostate cancer treatment
