A diagnosis of prostate cancer can wreck your world, leaving you feeling anxious, fearful and uncertain of your future.
While many men lean towards harmful prostate drugs and invasive surgery, recent research has suggested that men could be being overtreated for prostate cancer. A study published in the Journal of Urology evaluated the emotional distress of patients soon after diagnosis and after a treatment decision. It found that men who felt more anxious about their diagnosis were more likely to choose surgery over active surveillance. This was despite many patients being diagnosed with low-risk prostate cancer.
Although for some men surgery may be necessary, it can also have a number of negative side effects. For those suffering from low-risk prostate cancer, active surveillance could be of great benefit.
What Is Active Surveillance?
Active Surveillance is a means of monitoring prostate cancer when it hasn’t yet spread outside of the prostate. It is suitable for men with low-risk prostate cancer which has a low risk of spreading (localized prostate cancer). Active Surveillance includes grade group 1 or Gleason 6, a PSA level <10, cancer that is confined to the prostate.
While it has been ingrained in us by doctors to treat a problem with drugs and surgery immediately, alpha blocker drugs, surgery and radiation can have side effects that lessen a person’s quality of life. A benefit of monitoring low-risk cancer is that you might avoid having unnecessary surgery. In fact, one study of men undergoing active surveillance found that, 15 years later, less than 1% of men developed metastatic disease.
For many men, the idea of not treating a problem straight away might seem strange. However, while active surveillance does not require treatment, it does involve constant supervision by your doctor and it is a structured program that will involve both tests and check-ups.
Once you have discussed starting active surveillance with your doctor, you will be reviewed in a clinic at 3 months.
- PSA Test – The PSA Test is a blood test that measures the amount of prostate specific antigen (PSA) in your blood. PSA is a protein produced by normal cells in the prostate and also by prostate cancer cells. As men age, their PSA naturally increases, and a high PSA is not always indicative of prostate cancer. This test will be done every three months for two years, then every six months from then on.
- DRE – The doctor might recommend a DRE (digital rectal exam) to further check your prostate. In this procedure, the doctor or nurse feels your prostate through the wall of the rectum by sliding a finger gently into your anus. This is done to feel for any hard or lumpy areas in your prostate, and to get an idea of its size.
- MRI – An MRI scan creates a detailed image of your prostate and the surrounding tissues. This allows the doctor to check whether there is cancer and how fast the cancer is spreading.
- Biopsy – During this process, your doctor may suggest a biopsy. This will usually be done when PSA test results are higher than normal or if your doctor detects a prostate problem during your DRE. However, it should be noted that a biopsy can have a number of risk and life-changing side effects, including infection, sexual incontinence and even the spreading of prostate cancer cells.
- As no surgery is involved you will not experience any dangerous side effects, which could lessen the quality of your life.
- It will not affect your everyday life as much as surgery or radiation treatment.
- Some men may feel anxious at the thought of not having treatment and worry about their cancer growing.
- Your cancer might grow more quickly than expected and become harder to treat – but this is very uncommon.
- You may need to have more biopsies, which as mentioned, can have a number of risks and uncomfortable side effects.
Active Surveillance vs Watchful Waiting
When searching for information about active surveillance, you may have come across the term watchful waiting. The two are very different and should not be confused with one another. Although both are used as a way to avoid unnecessary treatment, they have their differences.
Active Surveillance- Monitors prostate cancer more closely, involving a range of periodic tests. It is generally recommended for men with low-risk prostate cancer and never for those diagnosed with high-risk cancer. If your results change your doctor will then proceed to discuss treatment options.
Watchful Waiting- Is usually used by men experiencing other health problems, who may be unable to handle surgery or radiotherapy. It can be used in men with both low-risk cancer or men whose cancer has spread (advanced cancer). It involves fewer tests than active surveillance and is less intensive, more often than not taking place at the GP surgery than a hospital. If you do have treatment in the future, it will aim to control the cancer and manage any symptoms, rather than to cure it.
A diagnosis of prostate cancer can leave you feeling vulnerable, but by taking the right steps and being aware of treatment options, it can be treated. While active surveillance may not be for everyone, if you do have low-risk prostate cancer, it could be a good option. Before undergoing surgery, which might not be necessary, do your homework and discuss your options with your doctor.
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