Treating Low-Risk Prostate Cancer
- “Real Housewives of New Jersey” star Margaret Josephs, 58, has shared that her husband, Joe Benigno, 70, is “feeling great” and that his prostate cancer condition has remained stable since his diagnosis.
- Active surveillance is more hands-on than the name implies. It typically involves routine physical exams, blood tests, biopsies, and imaging as part of the ongoing monitoring process.
- 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 tells SurvivorNet that 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 wailful 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.
What Happens if My PSA Test is Elevated?
Read MoreJosephs further told The Daily Dish, “He just had a very big birthday. He just turned 70 the day before we left for BravoCon. Do you believe he’s 70? He looks unbelievable. BravoCon is his birthday party.”
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Josephs further praised “the love of her life” in a sweet birthday post on Instagram.
She wrote alongside a carousel of photos, “You are the anchor of our family. You wake up everyday with a smile, you are kind, generous, funny, warm, loving, can fix anything and have all your hair!!
“You make me a better person. Our life is going to fast because I want endless time with you and that won’t be enough. I love you beyond words.”
During an August 2024 interview on the “Taste of Taylor” podcast, Josephs offered more insight into her Benigno’s diagnosis and choice to follow an active surveillance approach.
“The truth is he does have first stage prostate cancer, but he’s OK,” Josephs explained, noting how a genomic test was done to determine how fast the cancer grows.
“His is 97% slow-growing, so they don’t treat it. They do something called active surveillance, he gets tested every four months to see if it changes.”
Expert Resources On Prostate Cancer
- Rod Stewart and Millions of Other Men Have Been Treated for Prostate Cancer — Now A New 10-Year Study Confirms Effectiveness of ‘Watch-and-Wait’ Approach in Low-Risk Cases
- There’s No One Definitive Symptom for Prostate Cancer, But There Are Clues
- ‘A Profound Effect’: Treating Advanced Prostate Cancer With Hormone Therapy
- Advanced Prostate Cancer: Treatment For Metastatic Lesions To The Bone
- Don’t Believe the Hype: Do Your Own Research on Prostate Cancer Treatment
- Dr. Shirin Razdan’s Guide To Treatment & Living With Prostate Cancer
- Monitoring After Prostate Cancer Treatment; How Is Recurrence Defined?
Bengino’s cancer as of that interview showed no changes and remained stable, limited to two tiny, microscopic areas, his wife said, noting how because he was diagnosed with this type of cancer at a later age, the probably of it growing is unlikely.
She added, “They said it might not grow for 10 years. So, they just check him every few months, he goes for MRIs and blood tests every few months and we just keep it under control that way.”
The approach his doctors have chosen to take can also be called 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,” Dr. James Brooks, a urologic oncologist at Stanford Hospital & Clinics and an Associate Professor in the School of Medicine, told SurvivorNet in an earlier interview.
“You don’t have to suffer some of those potential side effects of sexual dysfunction or urinary dysfunction,” Dr. Brooks continued.
If wailful 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.
Explaining why her husband opted against removing the cancer, Josephs said it’s “completely curable,” but the treatment carries significant side effects they hoped to avoid.
Understanding What Led To Joe Bengino’s Diagnosis
In a July 2024 episode of “The Real Housewives of New Jersey,” Benigno’s bloodwork revealed elevated prostate-specific antigen levels.
It’s important to understand that when men are screened for prostate cancer, a few tests may be utilized.
One of the tests is the PSA test, a simple blood test. It looks for larger amounts of protein-specific antigen (PSA) in the blood. Normal PSA levels typically range from 0 to 4 ng/mL, although this can vary slightly based on age and other health factors.
An elevated PSA test does not always mean you have prostate cancer, but the risk of getting it is greater. It could also reflect that your prostate is enlarged, which is common, or it could signal an infection or inflammation.
Your doctor may also conduct a digital rectal exam (DRE) to check your prostate for lumps.
“So for a patient that’s found to have an elevated PSA, oftentimes it’s the urologist that meets that patient first, typically referred from a primary care physician,” Dr. Jonathan Lischalk, radiation oncologist at Perlmutter Cancer Center, explains.
Depending on the results of these tests, imaging scans and a biopsy may be ordered.
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After tests, your doctor analyzes the results to give you a Gleason Score. This score ranges from 6 to 10. The higher the score, the more aggressive the cancer.
This score and your other test results help doctors determine whether your cancer is low, intermediate, or high risk.
WATCH: How Gleason Grade Determines Treatment
During the episode, Benigno’s doctor said, “There’s a chance that it’s prostate cancer.”
Benigno’s official diagnosis was found after he underwent additional testing.
What Are the Current Prostate Cancer Screening Guidelines?
The Centers for Disease Control and Prevention (CDC) and the U.S. Preventive Services Task Force (USPSTF) both recommend that men at average risk between the ages of 55 and 69 years talk with their doctor about the pros and cons of prostate cancer screening.
The American Cancer Society recommends that men at age 50 who are at average risk should begin screening. Men who are at high risk of prostate cancer should begin screening at age 45. Men with a close relative diagnosed with prostate cancer should consider annual screening at 40.
For men 70 years and older, the USPSTF and the CDC say potential benefits do not outweigh the expected harms and recommend that men 70 and older should not be routinely screened for prostate cancer.
How Is Prostate Cancer Staged?
The National Comprehensive Cancer Network (NCCN) guidelines divides prostate cancer into one of six risk categories based on how aggressive the cancer looks under the microscope and the chance of it coming back after treatment. These risk categories help guide treatment for the different subtypes of prostate cancers.
The main risk categories for prostate cancer are:
- Very-Low-Risk (VLR) and Low-Risk (LR)
- Favorable- (FIR) and Unfavorable-Intermediate-Risk (UFIR)
- High-Risk (HR) and Very-High-Risk (VHR)
Very-Low-Risk and Low-Risk Prostate Cancers
Prostate cancers classified as VLR or LR represent the least aggressive forms of cancer. This categorization will be diagnosed depending on number of factors, including:
- Your doctor can’t feel the cancer on a physical exam, or it occupies one-half or less of one side of the prostate
- Your PSA is less than 10
- Your total Gleason score is 6
If your cancer is categorized as VLR or LR, your doctor may recommend active surveillance, another name for “watch-and- wait,” as discussed in the study
Why consider active surveillance? The most common and effective treatments for prostate cancer are radiation therapy and surgery.
Despite their effectiveness, these treatments are associated with side effects. Specifically, radiation can cause erectile dysfunction, urinary frequency and urgency, and changes in bowel habits. Surgery also causes erectile dysfunction but also can cause urinary incontinence and urinary leakage.
Given that these side effects can significantly impact the quality of life it is important to only treat prostate cancer when it is necessary to avoid these potential complications.
Who is a Candidate for Active Surveillance?
Not all men with prostate cancer are potential candidates for active surveillance. Active surveillance is only recommended for men with low-risk prostate cancer who are capable and willing to follow a very close and active follow-up schedule. Low-risk prostate cancer is slow growing and is biologically less aggressive compared with higher-risk prostate cancer.
“With low-risk prostate cancer, your risk of cancer getting out of the prostate and spreading to other parts of the body is really, really low,” Dr. Stephen Freedland, a urologist at Cedars-Sinai Medical Center, previously told SurvivorNet when discussing the topic.
RELATED: People With Low-Risk Prostate Cancer Can Rely on Monitoring the Disease
Men who have low-risk cancer can choose this approach and avoid the potential complications that come with treatment with surgery and radiation. Because the risk of the cancer spreading outside of the prostate is extremely low in men with low-risk disease, this approach is an effective option for men.
Active surveillance includes a PSA test, rectal exam and high-quality imaging tests, which can identify minuscule yet important changes.
When Is Active Surveillance Not Enough?
If you have been diagnosed with moderate-risk cancer, it can be a slippery slope. Something about the cancer isn’t low grade enough to be considered low risk, and many men choose to begin active treatment at this point. Active treatment involves removing the entire prostate, radiation or cryotherapy.
Bottom line, active surveillance is only a great option for men with low-risk prostate cancer who can follow a very active follow-up protocol. Active surveillance allows about 50 percent of men to avoid over-treatment and side effects.
The protocol is designed to identify early signs of cancer growth or an increase in aggressiveness and these factors will indicate treatment is necessary.
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?
Contributing: SurvivorNet Staff
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