Facing Prostate Cancer Through Active Surveillance
- British actor Colin McFarlane, 61, was diagnosed with prostate cancer after undergoing a routine prostate-specific antigen (PSA) test. This test measures the level of PSA in the blood, and higher levels can indicate cancer.
- He said he caught it early, it is low risk (slow growing), and he is being monitored (an approach called active surveillance).
- If you have been diagnosed with prostate cancer, doctors will first determine if you are at a low, intermediate, or high risk based on your PSA levels, imaging scans, a prostate exam and other tests. Your age and overall health also factor into what will be the best course of treatment for you.
- Active surveillance can help men with low-risk prostate cancer avoid aggressive treatment. It typically involves at least bi-annual PSA assessments, annual digital rectal examinations, and repeat biopsies no more frequently than once per year. Additional tests may also be ordered like imaging scans.
The 61-year-old father of one, known for his roles in “Batman Begins,” “The Dark Knight,” and “Crawl,” is now being monitored (an approach called active surveillance) and his cancer has been deemed “very low risk.”
Read MoreA PSA test measures the level of PSA in the blood.
Speaking on BBC’s Breakfast program on Monday in an effort to raise awareness alongside Prostate Cancer UK’s campaign to inspire Black men over age 45 and others over age 50 to get a PSA testMcFarlane shared the news of his cancer diagnosis.
“Please do what I did and do your regular blood tests because if you do a PSA test every year, you’ll be as lucky as I’ve been and you’ll catch it early and that’s the key,” he urged.
“I am being regularly monitored with PSA blood tests every three months and an MRI (or magnetic resonance imaging scan) once a year,” said of his active surveillance.
Important words from @colinmcfarlane on BBC Breakfast this morning. 👇
Knowing your risk could save your life: https://t.co/epqiqKBvDP #MensHealthWeek pic.twitter.com/oTqHHl9onx
— Prostate Cancer UK (@ProstateUK) June 12, 2023
McFarlane, who received his diagnosis on his late mother’s birthday, continued, “As it's a very slow-moving cancer I am in the best possible position to ascertain what treatment I would need in the future if that were ever deemed necessary, and currently that scenario is a long way off.
“It's men who take no action and don't know anything about their prostate health that are at the greatest risk.”
Following his announcement, McFarlane took to Twitter to insist he’s “absolutely fine” despite his diagnosis.
“I’M ABSOLUTELY FINE!,” he tweeted, “But thank you for all the supportive messages [regarding] my prostate cancer diagnosis.”
He concluded, “MEN PLEASE DO WHAT I DID AND YOU TOO CAN BE LUCKY.”
I’M ABSOLUTELY FINE!
But thank you for all the supportive messages re my prostate cancer diagnosis.
CAUGHT EARLY
NO TREATMENT NEEDED
NO SYMPTOMS OR PAIN.
VERY LOW RISKMEN PLEASE DO WHAT I DID AND YOU TOO CAN BE LUCKY.
Go to @ProstateUK risk checker & learn more🙏🏽☺️ pic.twitter.com/dSOpnZCKJW— Colin McFarlane🙏🏽🇺🇦 (@colinmcfarlane) June 12, 2023
Treatment Options for Prostate Cancer
If you have been diagnosed with prostate cancer, doctors will first determine if you are at a low, intermediate, or high risk based on your PSA levels, imaging scans, a prostate exam and other tests. Your age and overall health also factor into what will be the best course of treatment for you.
RELATED: Guide to Prostate Cancer: Overview
Common treatment options for men with prostate cancer include:
- Surgery
- Radiation therapy
- Active surveillance
- Combination radiation therapy with hormonal therapy
- Surgery followed by radiation therapy
The reality is that most treatments are effective at curing the cancer. However, they each have different side effects that your doctors should discuss with you.
If prostate cancer has metastasized (spread to other parts of your body), your doctor might suggest hormone therapy, chemotherapy, radiation therapy, or a combination of these therapies.
Expert Prostate Cancer Resources
- There’s No One Definitive Symptom for Prostate Cancer, But There Are Clues
- Decorated Navy Veteran Reverses Devastating Prognosis With New Treatment for Prostate Cancer
- How to Treat Late-Stage Prostate Cancer: New Treatment Developments
- New Hope For Advanced Prostate Cancer: Delivering Radiation at The Cellular Level — Understanding Pluvicto, Now Approved By The FDA
- New Drug for Advanced Prostate Cancer Gets Fast-Tracked by FDA; What You Need to Know About This Treatment
Anti-androgen therapy or hormone therapy is the backbone of treatment for metastatic prostate cancer. Prostate cancer uses testosterone to grow, and these therapies turn your body's testosterone off, slowing cancer growth.
In addition to hormone therapy, your doctor may recommend chemotherapy.
According to the National Cancer Institute (NCI), the eight types of standard treatment for prostate cancer includes watchful waiting or active surveillance, surgery, radiation therapy and radiopharmaceutical therapy, hormone therapy, chemotherapy, targeted therapy, immunotherapy, and bisphosphonate therapy
The Challenge of Deciding When to Treat Prostate Cancer
Other types of treatment could be done for bone pain stemming from bone metastases or hormone therapy.
There are also new treatment options being tested in clinical trials. Other forms of treatment could be cryosurgery, high-intensityfocused ultrasound therapy, proton beam radiation therapy, and photodynamic therapy, the NCI explains.
Surveillance & Low-Risk Disease
In men who meet all criteria for low-risk prostate cancer, there is an option that avoids aggressive treatment and is called active surveillance. This group of men may not require immediate treatment.
By taking an active surveillance approach, aggressive treatment side effects may be completely avoided or postponed for many years until the cancer grows or becomes more aggressive. This can lead to improved quality of life after diagnosis.
The active surveillance approach is not watchful waiting or doing nothing. Instead, it’s a method to closely monitor prostate cancer. If the prostate cancer begins to grow, become more aggressive, or you desire treatment, these are all reasons to stop active surveillance and begin treatment.
Active surveillance typically consists of:
- At least bi-annual PSA assessments
- Annual digital rectal examinations
- Repeat biopsies no more frequently than once per year
- Additional tests may also be ordered like a prostate MRI or genetic testing with Decipher Genomics
This approach allows doctors to keep a very close eye on the cancer. If the cancer remains low risk and does not show signs of growth or an increase in aggressiveness you can continue with active surveillance and avoid the side effects that come with treatment.
Don't Believe the Hype: Do Your Own Research on Prostate Cancer Treatment
Studies have shown that in properly selected men with low-risk prostate cancer, about half of men who have active surveillance will be able to avoid unnecessary treatments.
These same studies show that in properly selected men with low-risk cancer, there is no difference in survival between active surveillance and immediate radical treatment as both options have excellent outcomes given the relative non-aggressive nature of low-risk disease.
Surgery Options for Prostate Cancer & Treatment For High-Risk Disease
Men at higher risk with more aggressive disease may receive more intense treatment.
Sugery
For men with any risk group of prostate cancer that hasn't spread outside of the prostate gland, surgery will be an option.
Normally, the type of surgery used is called a radical prostatectomy, which involves removing the entire prostate and some tissue around it, including the seminal vesicles that release fluid into the semen.
This procedure can be performed as an open procedure, through one large incision. The surgeon may also make several small incisions, called laparoscopic surgery.
“It's typically done through a robotic technique today, at least in the United States, but a lot of patients are still getting open surgery,” Dr. Stephen Freedland, a urologist at Cedars-Sinai Medical Center, previously told SurvivorNet.
“Depending on the surgeon, it may be two, three, four, five hours somewhere in that range, usually spend one night in the hospital. You wake up from the surgery with a catheter in your bladder. Once you're home, it's really just recovering, gaining your strength back.”
Genetic Testing for Advanced Prostate Cancer Can Help Tailor Treatment
Radiation Therapy
You'll usually get radiation treatment five days a week for several weeks. Newer techniques include stereotactic body radiotherapy (SBRT), which aims more focused beams of radiation at the tumor, to spare surrounding healthy tissues, and may allow treatment in a shorter time.
Brachytherapy implants small seeds containing radiation directly into your prostate. This type of radiation works best in men with smaller prostates.
If your prostate is very large, your doctor might give you hormone therapy first to shrink it.
Combination radiation therapy with hormonal therapy
Androgens are male hormones that fuel the growth of prostate cancer. Androgen deprivation therapy (ADT), also known as hormone therapy, reduces levels of these hormones your body makes, to slow the cancer's growth.
"Usually, for men with tumors that spread, hormonal therapy is usually the first line that we do, and more importantly, it's the backbone upon which we build," Dr. Freedland explained to SurvivorNet.
Surgery followed by radiation
Radiation therapy can be used after surgery, to get rid of any cancer cells that were left behind. Getting radiation along with surgery is called adjuvant therapy.
Sometimes, men who have surgery will need radiation therapy after surgery if the surgeon could not remove all of the prostate, your PSA does not become undetectable, or you have a high-risk genetic profile if the tissue is sent for testing.
Men with high-risk and very high-risk prostate cancer are more likely to require radiation after surgery than men with lower-risk disease.
Contributing: SurvivorNet Staff
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