Prostate Cancer

What Is Active Surveillance?

Being diagnosed with prostate cancer can wreck your world, leaving you feeling anxious, fearful, and uncertain of your future.

While many men lean towards harmful prostate drugs and invasive surgery, recent research has suggested that men could be being overtreated for prostate cancer.

A study published in the Journal of Urology evaluated the emotional distress of patients soon after diagnosis and after a treatment decision.

It found that men who felt more anxious about their diagnosis were more likely to choose surgery over active surveillance. This was despite many patients being diagnosed with low-risk prostate cancer.

Although for some men, surgery may be necessary, it can also have a number of adverse side effects. For those suffering from low-risk, localized prostate cancer, active surveillance could be of great benefit.

What Is Active Surveillance?

Active surveillance is a means of monitoring prostate cancer when it hasn’t yet spread outside of the prostate.

It is suitable for men with low-risk prostate cancer, which has a low risk of spreading (localized prostate cancer).

Active surveillance includes grade group 1 or Gleason 6, a PSA level <10, cancer that is confined to the prostate.

While it has been ingrained in us by doctors to treat a problem with drugs and surgery immediately, alpha blocker drugs, surgery, and radiation can have side effects that lessen a person’s quality of life.

A benefit of monitoring low-risk cancer is that you might avoid having unnecessary surgery. In fact, one study of men undergoing active surveillance found that, 15 years later, less than 1% of men developed metastatic disease.

Tests

For many men, the idea of not treating a problem straight away might seem strange.

However, while active surveillance does not require treatment, it does involve constant supervision by your Doctor, and it is a structured program that will involve both PSA tests and check-ups.

Once you have discussed starting active surveillance with your doctor, you will be reviewed in a clinic at three months.

PSA Test

PSA Testing is a blood test that measures the amount of prostate-specific antigen (PSA) in your blood. PSA is a protein produced by normal cells in the prostate and also by prostate cancer cells.

As men age, their PSA naturally increases, and a high PSA is not always indicative of prostate cancer. This test will be done every three months for two years, then every six months from then on.

DRE

The Doctor might recommend a DRE (digital rectal exam) to check your prostate further. In this procedure, the doctor or nurse feels your prostate through the wall of the rectum by sliding a finger gently into your anus.

This is done to feel for any hard or lumpy areas in your prostate, and to get an idea of its size.

MRI Magnetic resonance imaging

An MRI scan creates a detailed image of your prostate and the surrounding tissues. This allows the doctor to check whether there is cancer and disease progression.

Biopsy

During this process, your doctor may suggest a prostate biopsy. This will usually be done when PSA test results are higher than normal or if your doctor detects a prostate problem during your DRE.

It should be noted that a biopsy can have several risks and life-changing side effects. This includes infection, sexual incontinence, urinary incontinence, and even the spreading of prostate cancer cells.

Advantages

As no aggressive treatment is involved, you will not experience any dangerous side effects, which could lessen the quality of your life. It will not affect your everyday life as much as surgery or radiation therapy.

Disadvantages

Some men may feel anxious at the thought of not having treatment. Your cancer might grow more quickly than expected and become harder to treat – but this is very uncommon.

You may need to have more biopsies, which, as mentioned, can have many risks and uncomfortable side effects.

Active Surveillance vs. Watchful Waiting

When searching for information about active surveillance, you may have come across the term watchful waiting.

The two are very different and should not be confused with one another. Although both are used as a way to avoid unnecessary treatment, they have their differences.

Active Surveillance

Active surveillance monitors prostate cancer more closely, involving a range of periodic tests. It is generally recommended for men with low-risk prostate cancer and never for those diagnosed with high-risk cancer. If your results change, your Doctor will then proceed to discuss treatment options.

Watchful Waiting

Watchful waiting is usually used by men experiencing other health problems, who may be unable to handle surgery or radiotherapy. It can be used in men with both low-risk cancer or men whose cancer has spread (advanced cancer).

It involves fewer tests than active surveillance and is less intensive. More often than it takes place at the GP surgery instead of a hospital. If you do have treatment in the future, it will aim to control cancer and manage any symptoms, rather than to cure it.

Conclusion

Being diagnosed with prostate cancer can leave you feeling vulnerable. However, by taking the right steps and being aware of treatment options, it can be treated.

While prostate cancer active surveillance may not be for everyone, if you do have low-risk prostate cancer, monitoring its progression could be a good option. Before undergoing prostate cancer treatment, which might not be necessary, do your homework and discuss your options with your Doctor.

Sources

  1. van den Bergh RC, Vasarainen H, van der Poel HG, Vis-Maters JJ, Rietbergen JB, Pickles T, Cornel EB. (2010). Short-term outcomes of the prospective multicentre ‘Prostate Cancer Research International: Active Surveillance’ study.. BJU International . 105 (7), p956-962.
  2. Kim C, Wright FC, Look Hong NJ, Groot G, Helyer L, Meiers P, et al.. (2018). Patient and provider experiences with active surveillance: A scoping review. PLOS ONE. 13 (2), 0.Roobol, M. (2018). Prostate cancer screening and active surveillance in the Western world. Translation Andrology and Urology. 7 (1), p1-2.
  3. O Tikkinen, K, Dahm, P, Lytvyn, L, et al. (2018). Prostate cancer with prostate-specific antigen (PSA) test: a clinical practice guideline. BMJ. 362 (0), 0.
  4. Thomsen FB, Jakobsen H, Langkilde NC, Borre M, Jakobsen EB, Frey A, Lund L, Lunden D, Dahl C, Helgstrand JT, Brasso K. (2019). Active Surveillance for Localized Prostate Cancer: Nationwide Observational Study.. The Journal of Urology. 201 (3), p520-527.
  5. Bill-Axelson, A, Holmberg, L, Garmo, H, Taari, K. (2018). Radical Prostatectomy or Watchful Waiting in Prostate Cancer — 29-Year Follow-up. The New England Journal of Medicine . 379 (0), p2319-2329.
  6. Klot, L. (2016). Current Status of Clinical Trials in Active Surveillance. In: Stone, Nelson N., Crawford, E. David The prostate cancer dilemma: Selecting patients for active surveillance, focal ablation and definitive therapy. USA: Springer International Publishing. p141-152.

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