- New research supports the fact that low-risk prostate cancer can be managed through monitoring and without the need for radical intervention, like surgery or radiation.
- A new study found that people with low-risk prostate cancer who managed the disease through monitoring did not have an increase in their risk of death from it in 15 years.
- This helps support that low-risk prostate cancer patients can avoid the side effects of aggressive treatment like surgery, which can lead to leakage or erectile dysfunction.
- Monitoring, or active surveillance, very active protocol that allows your cancer team to closely monitor the cancer for changes, and it can be tailored to your specific circumstances
The study, published in the New England Journal of Medicine, followed 1,643 men diagnosed with prostate cancer to evaluate the effectiveness of treatment options. About a third were assigned to active monitoring treatment, which can include regular physical exams, bloodwork, biopsies, and imaging, as needed. Another third were assigned to undergo surgery to remove all or part of the prostate, and the last third were assigned to receive radiation therapy.Read More
So with this new research, weighing these potential side effects of radical treatment options against the promosing outcomes seen with a monitoring approach can aid you in making a decision with your doctor to treat your low-risk prostate cancer.
Monitoring as a Safe Option for Low-Risk Prostate Cancer
The study is part of a breadth of research that supports the safe use of monitoring as a treatment options for low-risk prostate cancer.
Monitoring is also called active surveillance, and it 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 such as the Decipher genomic analysis. All of these tests are designed to monitor the cancer and catch any change early.
“Lord of the Rings” actor Ian McKellan is a a public example of taking the monitoring approach to treat prostate cancer. After being diagnosed in 2006, he opted not to have surgery or other aggressive treatment. “There is no cause for alarm. I am examined regularly and the cancer is contained,” he wrote on his blog in 2012.
Dr. Wise added that the monitoring protocol is also not one-size-fits-all, and that it would be tailored to the patient’s life expectancy and competing medical problems.
“Patients and physicians need to understand the surprising concept that prostate cancers are not all the same. Whether prostate cancer needs to be treated or monitored, depends on multiple risk factors,” Dr. Wise said.
It’s important to discuss your specific circumstances with your doctor to understand the best options available to you. For example, the incidence of prostate cancer in African-American men is 60% higher, and they are two to three times more likely to die from the disease. That’s in part because they tend to get a more aggressive form, and they are also more likely to be diagnosed at a more advanced stage.
And while the risk of death was comparable across the three treatment plans – surveillance, surgery and raditation – that could be because those with higher risk disease were treated appropriately. This means that active surveillance may be appropriate for some but not for others.
“The risk of the cancer is the key take home message from this trial,” Dr. Wise added. “Low-risk cancer can be safely monitored. Advances in monitoring on a formal active surveillance protocol with a urologic oncologist should be strongly considered. Surgery and radiation should only be considered after a discussion of the risks and benefits of these treatments given the lack of survival benefit reported in this study and others.”
It’s important to note that active surveillance requires regular, close monitoring. It is dependent upon the patient taking some charge of their care and responsibly showing up for their appointments and getting their labwork done. If these seems like a treatment plan that would not be possible for you (for logistical or other reasons), then active surveillance may not be the right choice for you.
The Importance of PSA Screening for Prostate Cancer
Dr. Wise says that the increased research should also help shape the conversation around the importance of prostate-specific antigen (PSA) testing. It’s a simple blood test that's used to screen for prostate cancer and also to track a patient's response to treatment. PSA is the name of a protein secreted by the prostate gland, which men have a small amount of in their blood anyway. However, it’s when there’s a larger amount in the blood that cancer may be forming. When cancer cells grow, PSA spills into the blood.
It’s important to note that having elevated PSA does not always mean you have cancer. It could indicate an enlarged prostate – which is fairly common – or an infection or inflammation. So while the PSA test is not perfect in detecting cancer outright and could potentially lead to over-diagnosing or over-treatment, it is an extremely helpful tool for oncologists.
“PSA screening has been shown to lower the risk of prostate cancer-related death,” Dr. Wise explained. “However, not all abnormal PSAs necessitate a biopsy and not all prostate cancers found on biopsy necessitate radical treatment. However, by not testing at all, we are missing the early identification of aggressive prostate cancers that do benefit from intensive treatment. This is corroborated by the recent reports of the increasing incidence of metastatic prostate cancer (cancer that has spread to other areas of the body) linked to a drop in PSA screening rates.”