Prostate cancer is different from many cancers in that it varies greatly in how fast it grows. Not all prostate cancers need to be treated. No matter how young or old you are, the cancer may never become significant.
With the new PSA cutoff for suspicion of prostate cancer set at 2.5, many men are being diagnosed with very early stage prostate cancer. Depending on age and other details of the cancer, some men may not need any actual treatment. Your physician will be familiar with the "requirements" for Active Surveillance. These requirements are described below.
- With their physician's input, some prostate cancer patients choose not to have any definitive treatment but instead, use a "Watch and Wait" or "Active Surveillance" approach, thereby avoiding any unnecessary side effects. This decision can be made if the cancer is very small and confined to one area of the prostate, or is expected to grow at a slow rate.
- In addition, some older men with prostate cancer, and especially those who have other serious medical problems may never need any treatment because of the slow growth rate of the cancer. However, for most young men and/or in those whose life expectancy is greater than 10 years, a more definitive approach such as surgery or radiation therapy may be indicated. For psychological / personal reasons some men are too uncomfortable to know that cancer exists in their body and may rationally choose not to take the Active Surveillance path even though they can.
- The reason that the term "Watchful Waiting" has been changed to Active Surveillance is that it is an active process. You and your physician are not just waiting around, doing nothing. It is very important that the cancer be observed and monitored to reduce the risk of it developing undetected into a more serious form. Men who undertake Active Surveillance need to be followed closely and regularly by their physicians. They should also very seriously consider making changes in their lifestyle, getting plenty of exercise, modifying their diets, and taking appropriate supplements.
The following steps are suggested to reduce the risks involved in undertaking a watchful waiting approach:
Initially: Confirm the grade and volume of the cancer with a second review of the biopsy slides if necessary.
- As needed, ensure that an adequate biopsy with 10 to 12 cores has been performed.
- Obtain a baseline transrectal ultrasound to confirm the location and extent of the disease - usually done at the time of the biopsy.
Periodically: Monitor the DRE and total PSA regularly, as often as every three months.
- Repeat the transrectal ultrasound and the prostate needle biopsy every 12 to 24 months, depending on the results of the DRE and changes in the PSA.
- See your physician every 3 to 6 months to review test results and overall health situation.
Consider active treatment when: - A repeat biopsy shows an increase in volume, grade or stage of cancer.
- There is a steady rise in PSA over several tests.
- Transrectal ultrasound shows a significant increase in size of the cancer lesion(s).
Many men live for many years, even decades, while undergoing "Active Surveillance." The key to its successful implementation is a close and active partnership with a physician.
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