Understanding active surveillance for prostate cancer

When a man is told he has prostate cancer, a natural reaction is to want to get it out right away.  This normal response is understandable but not all prostate cancers are equally alike.  Sometimes prostate cancer is aggressive and a physician will want to act quickly to treat and remove it as soon as possible.  But some men’s prostate cancer are slow growing, not considered to be aggressive and the approach taken is more relaxed yet still concerned.

This is where the term active surveillance also called “watchful waiting” is a viable method of monitoring prostate cancer that falls into the category of being low-grade or is considered to be very slow growing and not likely to spread.  The concept of active surveillance has increasingly emerged as a viable option for men who decide not to undergo immediate treatment (surgery or radiation therapy) for prostate cancer.

Active surveillance will be considered by a physician to use to monitor a man’s prostate cancer if:

·      The tumor is small and limited to the prostate

·      The tumor is considered to be slow-growing and unlikely to spread (metastasize) or that the man’s chances of dying from the cancer is unlikely.

·      A man is elderly and is more likely to die from another cause

·      A man has other serious health problems

The term active surveillance is a means of monitoring the cancer closely with the goal to allow a man to have the highest quality of life while delaying or even completely avoiding invasive treatments.  Active surveillance is based on the concept that low-risk prostate cancer is unlikely to harm a man or reduce life expectancy. Over 30% of men have prostate cancers that are so slow growing that active surveillance is a better choice than immediate local treatment. Active surveillance is not to be confused as ‘no treatment,” but rather a strategy to treat a man only if and when his cancer warrants treatment.

Most physicians’ active surveillance programs involve seeing a man with prostate cancer every 6 months or yearly to keep a close eye on his disease.  The regular visits usually include a man getting a prostate specific antigen (PSA) blood test and a digital rectal exam (DRE).  Sometimes the physician may want to do periodic biopsies or MRIs of the prostate if he has concerns of it growing.    

Active surveillance is still considered a form of treatment but much less invasive.  Each time a man sees his physician for checking on his prostate cancer, the physician is evaluating the tumor for any signs of change and will reevaluate a man’s treatment if the cancer becomes more active.  If it is discovered that the PSA or Gleason score is beginning to rise, then the physician may recommend halting active surveillance and begin another form of treatment.

The goal of active surveillance is to determine that it is the right treatment for each individual man making certain that the cancer is confined to the prostate and does not appear to be aggressive.  The advantage of active surveillance for men with localized, slow-growing prostate cancer is they can avoid potential side effects of surgery or radiation therapy, such as urinary incontinence, rectal bleeding, and erectile dysfunction.

During active surveillance, a man is encouraged to make lifestyle changes such as eating a healthy diet and exercising which studies have shown can help decrease the risk of prostate cancer disease progression.

Men who receive a prostate cancer diagnosis and are given the recommendation by their physician to monitor their disease with active surveillance, need to question and understand his physician’s reasoning for the decision and to feel comfortable with the treatment recommended. At any time if a man feels uncomfortable with active surveillance, he should meet with his physician expressing his concerns where together they can agree on which treatment method is best.