A Gamechanger in Prostate Cancer
- Prostate cancer is the most common type of cancer in males, typically affecting 1 in 8 during their lifetime — including rock icon Rod Stewart. Stewart underwent treatment, but a new study indicates many men may not have to.
- In recent years, treatment protocol has been changing, and now a 10-year study’s findings reveal there is no significant difference between using a “watch-and-wait” approach, or active surveillance, to monitor a tumor vs. undergoing treatment in early-stage cases.
- The most common and effective treatments for prostate cancer are radiation therapy and surgery. Despite their effectiveness, these treatments are associated with side effects. 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.
- The study monitored 2,155 low-risk patients for almost a decade and found that almost half never needed treatment at all. Bottom line: active surveillance is a great option for some men with low-risk prostate cancer.
In recent years, treatment protocol has been changing, and while active surveillance was initially met with some controversy by the medical community, now a groundbreaking 10-year study‘s findings reveal there is no significant difference between using a “watch-and-wait” approach to monitor a tumor vs. undergoing treatment in low-risk cases. Keep in mind that early-stage does not always mean low-risk.
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The study, led by PhD scientist and cancer prevention researcher Lisa Newcomb out of Fred Hutchinson Cancer Center in Seattle, followed 2,155 patients for almost a decade.
“Our study showed that using active surveillance that includes regular PSA exams and prostate biopsies is a safe and effective management strategy for favorable-risk prostate cancer,” Newcomb stated in the Journal of the American Medical Association on Thursday.
PSA, or protein-specific antigen, is the name of a protein secreted by the prostate gland. Men have a small amount of PSA in their blood all the time but large amounts may signal that something is brewing. When cancer cells grow, PSA spills into the blood.
All of the men studied, with the average age being 63, had “favorable-risk prostate cancer and no prior treatment.” Near the end of the 10-year monitoring period, almost half never needed treatment at all.
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.
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