For many years, most men with prostate cancer were given the option of either surgery or radiation. Over time, doctors saw many men had prostate cancer that was less aggressive and unlikely to spread to other parts of the body or shorten lifespan. Doctors were also learning that many of these men were experiencing the downsides of prostate cancer treatment (e.g. difficulty with erections, leakage of urine) without benefit.
In response to “over treatment”, some centers offered men with low-risk prostate cancer prognosis were enrolled in a clinical trial of “active surveillance”. After 15 years of follow-up, half of the patients were able to avoid prostate cancer treatment. Today, these studies—with nearly 20 years follow-up—show excellent results of active surveillance for low-risk prostate cancer.
Men with low prostate-specific antigen (PSA) test results, low-grade tumors, and minimal abnormalities on the prostate exam are considered for the newer protocols. Active surveillance programs usually involve repeat biopsies every one to two years and PSA tests every three to six months. Treatment is recommended if the patient is found to have higher-risk disease.
It is difficult to hear a cancer diagnosis and then be presented with surveillance as an option to avoid treatment. Yet, cancer patients can trust that active surveillance is a process that can delay or avoid cancer treatment side effects with rare risk of death from prostate cancer. Newer technologies, like multiparametric magnetic-resonance imaging and molecular biomarkers, may identify more prostate cancer patients who would benefit from active surveillance.
In the end, among selected patients on active surveillance, death or progression of cancer is rare. There is no evidence that prostate cancer patients who undergo delayed prostate cancer treatment fare worse than those treated immediately. In fact, they avoid the side effects of cancer treatment over that time. If newly diagnosed with prostate cancer, active surveillance may be an option worth discussing with your urologist or radiation oncologist.
The Prostate Cancer Support Group meets the 1st Wednesday of every month from 11:00 AM – 12:30 PM at the Clifton Campus. If you’re interested in further details visit: https://winshipcancer.emory.edu/about-us/events/
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About Dr. Filson
Christopher Filson, MD, MS, is an assistant professor of urology at Emory University School of Medicine. Dr. Filson started practicing with Emory Healthcare in July 2015. His main clinical specialties include robotic surgery, laparoscopic surgery, cystectomy, urinary diversion, prostatectomy and nephrectomy. Dr. Filson received his Medical Degree from University of Michigan in Ann Arbor MI. His postdoctoral training included a surgery internship and urology residency also at University of Michigan and a Fellowship in Urologic Oncology at University of California Los Angeles.