Active Surveillance for Prostate Cancer
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Prostate cancer is the most common solid malignancy in men in the United States. According to the American Cancer Society, an estimated 288,000 men nationwide will be diagnosed with the disease in 2023. Prostate cancer comes in all kinds of varieties, including serious and life-threatening cases all the way to the more common, nonaggressive forms that are typically age related. The disease tends to occur in men as they age, so the presence of coexisting diseases can play a role in choosing treatment options.
What Is Active Surveillance?
After diagnosis, if eligible, you might consider an active surveillance approach instead of seeking treatment right away. What does this mean? You would basically meet regularly with your doctor and go through periodic testing to monitor your prostate and make sure there is no meaningful change in your cancer.
This would include prostate-specific antigen (PSA) tests about every six months and a digital rectal exam (DRE) at least once a year. Your doctor is also likely to obtain either an MRI of the prostate or a repeat biopsy of the prostate at no more often than yearly intervals.
If there are changes in your results, your doctor might recommend taking a different approach and discuss other treatment methods, including surgery and radiation.
When Might Active Surveillance Be the Best Option?
Active surveillance for prostate cancer is appropriate in patients with lower-risk prostate cancers that show no evidence of having spread outside the prostate. Patients with high-risk prostate cancers would not be eligible for this approach.
Observation of cancer as a concept seems confusing at first, but if you are diagnosed with low-risk cancer, based on findings from your biopsy, active surveillance avoids any side effects associated with cancer treatments like surgery or hormone therapy. Monitoring the cancer hasn’t been shown to result in an unacceptable likelihood of the disease progressing.
In people with other serious illnesses or of advanced age, active surveillance may avoid difficult decisions relating to life expectancy. For example, an elderly gentleman with a lot of other conditions who is diagnosed with low-risk prostate cancer may not need to worry about treating it. It’s a tough conversation to have, but in these cases, other illnesses may be more severe and life-threatening, so treatment for that low-risk prostate cancer may not be needed.
Understandably, this is a difficult concept to accept. That being said, it’s important to have honest discussions with your family and your doctors about this treatment path.
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