Lakeview Health System
Prostate Cancer

Active Surveillance of Newly Diagnosed Prostate Cancer -Thomas Stormont, MD 

Prostate cancer is common, and autopsy studies have shown that about 30% of men over age 50, and 80% over 80 have prostate cancer. Fortunately, most prostate cancers are slow growing. In fact, if the tumor is classified as “low risk” there are recent studies that show that the vast majority of men >65 who undergo treatment will not live any longer. On the other hand, about 1 in 34 men in the US will die from prostate cancer. Thus, men with a new diagnosis of prostate cancer face a difficult question: Is my cancer potentially life threatening or can I leave it alone and watch it, at least for now? This article briefly describes the controversies and reasoning behind surveillance of newly diagnosed prostate cancer.

How is the cancer followed?
While there is no consensus amongst physicians, and each case is different, there are a couple of ways to follow prostate cancer. A passive approach (watchful waiting) is to get periodic exams (digital rectal) and PSA blood tests. A more involved approach, active surveillance, involves every 3-6 month PSA tests and repeat biopsies, recognizing that PSA testing alone does not detect tumor growth in 25% of patients.

Who is appropriate for surveillance?
There is no consenus, but generally this approach is more appropriate for men >65 who have low risk prostate cancer (low PSA, low grade, low stage). It may not be as appropriate for younger men, since they have more to lose if the tumor risk is underestimated.

What is the risk of active surveillance?
Of course, there is the worry for both patient and physician that by delaying treatment, a man’s quality of life and/or longevity will be compromised. However, 2 large recent studies have shown that while about 1 in 3 men have tumor progression within 5 yrs, there is no evidence that waiting to initiate treatment harms them.

What are some other reasons to consider surveillance?
As mentioned, prostate cancer is slow growing, and some research has shown that aggressive treatment may not prolong life. Also, there may be permanent side effects (urinary and sexual) that follow treatment. There is confusion over which treatment is the best, and sometimes multiple treatments may be necessary. Also, treatments may be costly.

What are some other reasons to not consider surveillance?
Some research suggests that aggressive treatment of prostate cancer can prolong life. There have been continuing improvements in treatments, with less complications. Also, there are better therapies for the  sexual and urinary side effects that can occur with prostate cancer treatments. Predicting prostate cancer growth can be inaccurate, and this can cause anxiety for the patient and the family. Finally, men who adopt surveillance may suffer more urinary symptoms as the prostate grows with age.

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