Treating Low-Risk Prostate Cancer
- Actor Ian McKellen, 84, is best known for his roles in the “Lord of the Rings” trilogy, “X-Men” and “The Hobbit” films. He was diagnosed with prostate cancer in 2006 but was considered “low risk.” He followed a “watch and wait” or active surveillance approach for treatment.
- Active surveillance is a more involved form of treatment than the name suggests. Regular physical exams, bloodwork, biopsies, and imaging are all included in this treatment approach.
- Men with low-risk prostate cancer have a small number of cancer cells and they are more likely to be recommended an active surveillance approach.
- Urologic oncologist Dr. James Brooks explained active surveillance allows patients to preserve normal functioning compared to prostate cancer treatment. Treatment like surgery comes with side effects that include sexual dysfunction or urinary dysfunction.
- If waitful watching is chosen, routine prostate cancer tests such as protein-specific antigen (PSA) tests, digital rectal examinations, and biopsies are not usually performed, but treatment may be recommended if prostate cancer causes symptoms, such as pain or blockage of the urinary tract.
Veteran actor Ian McKellen, 84, is aging gracefully and like fine wine, he believes he’s gotten better with time despite having dealt with prostate cancer. The “Lord of the Rings” actor indicated his cancer treatment rests in a “watch-and-wait” approach which experts say is effective for men with low-risk prostate cancer.
View this post on InstagramRead More“I just go on and I feel I’m 20, and somehow the spirit comes through,” McKellen previously said during an interview on the U.K.-based talk show “This Morning” to describe his health.
He was diagnosed with prostate cancer in 2006 but went public about his condition several years later. Despite his diagnosis, he claimed to be a “much better actor than [he] used to be” amid levity.
McKellen may be best known for his iconic role as wise “Gandalf the Grey” in the “Lord of the Rings” (LOTR) trilogy of films, with the last movie – “Return of the King” premiering in theaters in 2003.
McKellen also famously portrayed “Magneto” in the X-Men franchise, last playing the character in the 2014 movie “X-Men: Days of Future Past.” Much to fans’ delight, he reprised his role as “Gandalf” for The Hobbit franchise, which first premiered in 2012.
Although McKellen remains active throughout the London scene still acting in plays and serving as an LGBTQ activist he appears to be in good health. His prostate cancer diagnosis called for a “watch-and-wait” approach. This form of treatment is for men with low-risk prostate cancer. This means you have a small number of cancer cells.
With low-risk prostate cancer, a man’s risk of cancer getting out of the prostate and spreading to other parts of the body is “really, really low,” explains Dr. Stephen Freedland, a urologist at Cedars-Sinai Medical Center, “so anything we do is going to be overtreatment.” If you do opt for active surveillance, you’ll regularly need a PSA test, rectal exam, and high-quality imaging tests, which can identify small yet important changes.
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McKellen’s “Watch and Wait” Treatment Approach
McKellen’s diagnosis came about after he first began experiencing symptoms of prostate cancer. He found himself using the bathroom frequently throughout the night. This prompted him to seek his doctor for a check-up. After undergoing a biopsy, cancerous cells were discovered.
WATCH: The benefits of active surveillance.
“You are told what the situation is: you can have an operation but there is no point me having an operation because there is no need for it,” McKellen explained to the Mirror.
“When you have got it, you monitor it, and you have to be careful it doesn’t spread. But if it is contained in the prostate, it’s no big deal,” he added.
Mckellan said he follows “waitful watching” with his prostate cancer. This can also be referred to as monitoring, a common treatment option for people with early-stage or low-risk cancer.
“The issue with considering treatment versus active surveillance is with active surveillance you preserve your normal functioning,” says Dr. James Brooks, a urologic oncologist at Stanford Hospital & Clinics and an Associate Professor in the School of Medicine.
“You don’t have to suffer some of those potential side effects of sexual dysfunction or urinary dysfunction,” Dr. Brooks continued.
If waitful watching is chosen, routine PSA tests, digital rectal examinations, and biopsies are not usually performed, but treatment may be recommended if prostate cancer causes symptoms, such as pain or blockage of the urinary tract.
The prostate-specific antigen test is a blood test that screens for cancer; it can also track a person’s response to cancer treatment. PSA is a protein secreted by the prostate gland; a large amount of PSA in a person’s body can indicate that cancer cells are growing.
Another form of monitoring for low-risk prostate cancer is active surveillance, which includes regular physical exams, bloodwork, biopsies, and imaging, as needed.
According to a recent study, people with low-risk prostate cancer can manage the disease through monitoring without increasing their risk of death from it in 15 years. This highlights that radical intervention, such as prostate removal or radiation, and the side effects of those treatments may not be immediately needed.
In a study, published in the New England Journal of Medicine, that followed 1,643 men diagnosed with prostate cancer to evaluate the effectiveness of treatment options, about a third were assigned to active monitoring treatment. Another third was assigned to undergo surgery to remove all or part of the prostate, and the last third was assigned to receive radiation therapy.
The researchers followed up with the participants about 15 years later and found that the likelihood of death from prostate cancer remained low regardless of the treatment option.
This shows that the “likelihood of death was not further reduced by initial radical intervention,” Dr. David Wise, director of genitourinary medical oncology at NYU Langone’s Perlmutter Cancer Center, told SurvivorNet.
“Thus, the choice of therapy involves weighing trade-offs between benefits and harms associated with treatments for localized prostate cancer,” the study said.
Monitoring is not simply a “wait and watch” or “do nothing” approach. It is a very active protocol that allows your cancer team to closely monitor the cancer for changes.
Active surveillance usually involves:
- A PSA test every six months
- Repeat digital rectal examinations no more frequently than every year
- Repeat biopsies no more frequently than every year.
Other tests may also be used, such as advanced imaging with prostate MRIs, prostate MRI-fusion biopsies, and even genetic testing. All of these tests are designed to monitor the cancer and catch any changes early so they can be treated.
Questions for Your Doctor
If you have experienced symptoms associated with prostate cancer or have a screening coming up, here are some questions you may ask your doctor:
- If I have elevated PSA levels, what could be causing that besides cancer?
- How long will it take to learn if my PSA levels warrant further testing?
- What are the treatment options that are best suited for me based on my risk level?
- What financial resources exist to help me with the costs associated with treatment?
- How long will my potential treatment prevent me from working or continuing normal activities?