For men diagnosed with prostate cancer, one of the first questions that often arises is, “What are my treatment options?” Choosing a treatment path can feel daunting, especially given the range of options available. Factors like the cancer’s stage, grade, and the patient’s age and overall health significantly influence the recommended approach. Interestingly, for many men with early-stage prostate cancer, the most commonly recommended treatment is a watch-and-wait method known as active surveillance.
Prostate Cancer: An Overview
Prostate cancer is the second most commonly diagnosed cancer among men and the second leading cause of cancer-related deaths for men in the United States. While any cancer diagnosis can be overwhelming, prostate cancer found in its early stages generally has a high survival rate—around 98-99% five years post-diagnosis. This promising outlook, especially for early-stage cases, has made active surveillance the most frequently used approach for low-risk prostate cancer.
What is Active Surveillance?
Active surveillance, sometimes called “watchful waiting,” is a carefully monitored approach for deferring immediate treatment. Instead, the patient undergoes regular follow-up exams to track any changes in the cancer’s progression. These exams typically include a digital rectal exam (DRE) and prostate-specific antigen (PSA) tests every three to six months, along with prostate biopsies every one to two years.The goal is to catch any signs of progression early so that additional treatments, such as surgery or radiation, can be considered if the cancer shows signs of becoming more aggressive.
Who is a Candidate for Active Surveillance?
Active surveillance is generally recommended for men with:
Slow-growing prostate cancer
Cancer is confined to the prostate and not spreading
There is a low likelihood of cancer spreading
This approach is ideal for men who can commit to regular checkups and manage the mental aspect of living with cancer.
What to Expect with Active Surveillance
Men opting for active surveillance are still active participants in managing their health, adhering to regular checkups and screenings to stay informed about their condition. If there are any changes in the cancer’s progression, they may need to discuss additional treatment options, such as surgery or radiation therapy, with their medical team.
Pros and Cons of Active Surveillance
Pros:
Non-invasive: No surgery or hospitalization is involved.
No immediate side effects: Since it doesn’t require surgery or radiation, patients can avoid potential side effects associated with these treatments.
Advanced monitoring technology: Modern imaging techniques allow for more precise and reliable tracking of prostate cancer, making this approach safer and more effective.
Cons:
Less proactive approach: Active surveillance is a “wait-and-see” method, which can be difficult for some men.
Frequent follow-ups: It requires regular PSA tests, DREs, and potentially yearly biopsies, which can feel burdensome.
Risk of progression: There’s a chance the cancer could progress, which might limit treatment options or require additional interventions.
Psychological stress: Some men may find it challenging to live with cancer, even a slow-growing one, without taking immediate action.
Making the Decision
Active surveillance is a shared decision between a man and his medical team. Open discussions about the benefits and risks are crucial for understanding why active surveillance might be the best choice. Regular checkups provide peace of mind and ensure that if the cancer changes or progresses, the patient can swiftly pivot to another treatment.Ultimately, if at any point a man feels uncertain or stressed by this approach, he should reach out to his healthcare provider. Prostate cancer treatment is highly personal, and men should feel empowered to make adjustments as needed with their doctor’s guidance.Dr. David Samadiis the Director of Men’s Health and Urologic Oncology at St. Francis Hospital in Long Island. He’s a renowned and highly successful board certified Urologic Oncologist Expert and Robotic Surgeon in New York City, regarded as one of the leading prostate surgeons in the U.S., with a vast expertise in prostate cancer treatment and Robotic-Assisted Laparoscopic Prostatectomy. Dr. Samadi is a medical contributor to NewsMax TV and is also the author of two books, Prostate Cancer Now What? A Practical Guide to Diagnosis, Treatment, and Recovery and The Ultimate MANual, Dr. Samadi’s Guide to Men’s Health and Wellness, available online both on Amazon and Barnes & Noble. Visit Dr. Samadi’s websites at robotic oncolo gy and prostate cancer 911.
