Prostate cancer is no longer necessarily the doom diagnosis it used to be a few decades ago.
Aggressive treatment is rarely the first option. So what is the go-to approach instead these days?
Whereas surgery (removal of the prostate or ‘prostatectomy’) and further treatment (with radiation, hormone therapy, or chemotherapy) were common as the first line treatment back then, nowadays either Active Surveillance or Watchful Waiting are among the first options. This is the case when the cancer hasn’t progressed too far yet and is rather small, when it isn’t causing too serious symptoms, when it is relatively unaggressive (PSA levels < 10 ng/ml) and when it is expected to grow rather slowly (low Gleason score).
It’s become clear that prostate cancer often grows very slowly so that some men, especially those who are older or have other serious health problems, might never need treatment. Treating prostate cancer with surgery or radiation has risks and side effects that might affect the quality of life more severely than living with a mild cancer and would not necessarily mean having a longer life. On the other hand, when younger and otherwise healthy men are diagnosed with prostate cancer, treatment might be suggested more quickly. Each case will be evaluated individually and the best approach for your situation will be discussed with your doctor.
What is Active Surveillance?
Active Surveillance indicates that the cancer will be monitored closely. This approach is usually taken in case the cancer tends to be more aggressive. In practice, this usually means a blood test measuring prostate-specific-antigen (PSA) levels every 6 months and a digital rectal exam (DRE) every year. On top, every 1-3 years, a prostate biopsy or imaging tests may be done. If the results show no big changes of the cancer, active surveillance is continued. Yet, if the cancer is progressing, surgery or other more radical treatments might be considered and discussed.
What is Watchful Waiting?
When the prostate cancer is less aggressive and especially with older patients, Watchful Waiting takes a less intense approach to following up the cancer’s development. Which tests are done are usually based on the symptoms that one might experience. The goal of this approach is to mitigate the symptoms rather than to cure or eradicate the cancer. Quality of Life is top priority here.
REFERENCES
Bekelman JE, Rumble RB, Chen RC, Pisansky TM, Finelli A, Feifer A, et al. Clinically Localized Prostate Cancer: ASCO Clinical Practice Guideline Endorsement of an American Urological Association/American Society for Radiation Oncology/Society of Urologic Oncology Guideline. J Clin Oncol. 2018; 32: 3251-3258.
Chen RC, Rumble RB, Loblaw DA, Finelli A, Ehdaie B, Cooperberg MR, et al. Active Surveillance for the Management of Localized Prostate Cancer (Cancer Care Ontario Guideline): American Society of Clinical Oncology Clinical Practice Guideline Endorsement. J Clin Oncol. 2016 Jun 20;34(18):2182-90.
Nelson WG, Antonarakis ES, Carter HB, DeMarzo AM, DeWeese TL, et al. Chapter 81: Prostate Cancer. In: Niederhuber JE, Armitage JO, Doroshow JH, Kastan MB, Tepper JE, eds. Abeloff’s Clinical Oncology. 6th ed. Philadelphia, Pa: Elsevier; 2020.