When less is more for men with prostate cancer
As a urologic oncologist – a surgeon who handles tumors of the urinary tract – every week I see numerous men who have just been diagnosed with prostate cancer and are trying to decide what to do next.
This is the most common cancer in men, found in more than 220,000 Americans a year. But a large proportion harbor cancer that is low risk, meaning that it's unlikely to harm them. More and more evidence has emerged that it is extremely safe for some men to skip initial treatment, and instead opt for periodic testing to be sure the cancer is not becoming aggressive. Best candidates for active surveillance are those with a low prostate specific antigen (PSA) level (less than 10 ng/mL) and a Gleason Score of 6 (this number reports how aggressive cells look under the microscope).
Many men gladly sign up for this active surveillance strategy, but others are reluctant. Some don't want the diagnosis hanging over them; some worry about "missing the boat" on a cure, while others have doubts about the science of determining which cancers will be aggressive.
Active surveillance is not the best option for everyone, but here are some reasons to strongly consider it if you or a loved one is diagnosed with low-risk prostate cancer:
Active Surveillance Delays or Avoids Potential Treatment Side Effects: Cancer centers that pioneered this approach have reported that anywhere from one third to one half of men remain on active surveillance after as many as 15 years. Those who do end up getting treated, on average, delay treatment for approximately eight years. This means they also avoid or delay potential side effects, including impaired urinary, erectile or bowel function - all of which can affect quality of life.
Active Surveillance Keeps the Door Open for Safer/Better Treatments Down the Road: New medical therapies are being introduced at a rapid pace. Surgical and radiation strategies also continue to improve. More importantly, better understanding of prostate cancer's genomic signatures - how the cancer cell's DNA differs from the normal cell's - is emerging. This means that in the future we will be able to better identify men whose cancers are not destined to harm them. So opting for active surveillance now may mean benefitting from future discoveries.
For now, men with low risk prostate cancer should speak with their physician in detail about active surveillance. It's a safe strategy that is helping men delay and even avoid side effects of cancer treatment. Even for men who pride themselves on decisive action, when it comes to dealing with low-risk prostate cancer, dragging one's feet may be the best initial option.
Alexander Kutikov, M.D. is an associate professor of urologic oncology at Fox Chase Cancer Center
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