Typically when a man receives a diagnosis of cancer he wants to do something about it right away. However if it is early stage prostate cancer it is becoming more common for a man to choose to “watch and wait” or what is known as active surveillance.
Active surveillance means that a man and his doctor have chosen to forgo surgery or radiation for the time being and instead to monitor it regularly watching for any changes in growth. This approach is being accepted by more and more men as national data has found between 40 percent to 50 percent of men with early stage prostate cancer are choosing this option.
A couple of organizations along with academic urologists in major medical center have pushed active surveillance into the forefront as the preferred method of treatment for early stage prostate cancer.
The National Institutes of Health in 2011 found that men with small and harmless-looking tumors could safely take a ‘watch and wait’ approach which was also echoed by the American Society of Oncology guidelines released this year. The guidelines stated that men with a localized prostate tumor and had a Gleason score of 6 or less, could fall under active surveillance as a recommended disease management strategy.
The Gleason score is a system of grading cancer cells where a pathologist grades them from 3 to 5. Grade 1 and 2 are thought of as normal prostate cells. When a man is diagnosed with prostate cancer, the Gleason score can determine his course of treatment action. Half of all men are diagnosed with a low-risk tumor. That translates into a less than 1 percent chance of a man dying from his prostate cancer in the next 10 years. Research has found whether they chose aggressive treatment or active surveillance, it didn’t matter.
One thing to keep in mind is cancer is cancer meaning even early stage prostate cancer needs monitoring from time to time. The guidelines from the American Society of Clinical Oncology suggest several factors to consider when making treatment and management decisions. These include age, prostate cancer volume, patient preference, and ethnicity. The guidelines still recommend active surveillance protocols to include PSA testing, digital rectal exams, and serial prostate biopsies.
The younger the man, the more difficult the decision is on what to do. With a longer life expectancy than an older man, the tumor has a greater chance at some point of beginning to grow larger and become more aggressive. They most likely will need to have regular biopsies to keep track of the tumor and its growth. The problem with biopsies is the chance of risk of infections and because only small bits of tissue of the prostate are taken, there is also the possibility of missing more aggressive cancers.
Active surveillance may also sound more appealing to younger men as more radical treatment methods can result in complications such as impotence and incontinence that could last for many, many years.
Does this mean all men, no matter what their circumstances or age, if diagnosed with early stage prostate cancer can simply choose active surveillance and forget about the cancer inside them? This is where it gets a little less straightforward.
What throws a kink on whether a man should choose active surveillance or a more aggressive approach is the fact that there is not much data on the watch and wait approach which has only been used since 2000. Therefore the long-term outcomes of active surveillance are not crystal clear at this time. At least another decade or two is necessary to have more definitive answers on the best approach for these men.
In the meantime, a man with early stage prostate needs regular monitoring by his doctor to determine what is in his best interest and what will result in the best outcome for him. Until more questions are answered, active surveillance is a viable option for these men.