Prostate Cancer Treatment Plans are Changing
- Former U.S. Senator John Kerry, 80, underwent surgery in 2003 to treat early-stage prostate cancer after his wife Teresa Heinz, 85, combed over his routine blood test and saw some red flags.
- Following his diagnosis and immediate surgery, the attorney, who currently serves as U.S. Special Presidential Envoy for Climate, was deemed cancer-free.
- 20 years ago, it was the norm to treat the disease right away. Now, however, many experts follow an active surveillance model, or even a “watch and wait,” to keep a close eye on the slow-growing cancer, but not everyone agrees.
- Every treatment or nontreatment comes with its own set of risks and benefits: the same is true of active surveillance. This approach is generally not recommended for men with high or intermediate-risk prostate cancer. It also might not be ideal for men who would feel extremely anxious about having cancer and not treating it. It’s a very individual choice you should discuss with your doctor.
“John became very aware what great health care delivered him,” Heinz told the New York Post at the time.
What Is ‘Active Surveillance’
The first thing to know about active surveillance is that it is active, Active surveillance is literally not a watch and wait approach nor is it a do-nothing approach. It is an approach supported by a large, randomized study as an option for men who met certain criteria and have low-risk prostate cancer. Active surveillance includes a PSA (prostate-specific antigen) test, rectal exam and high-quality imaging tests, which can identify minuscule yet important changes.Prostate cancer is the most diagnosed cancer in men and fortunately due to multiple effective treatment options has a favorable prognosis. The most common and effective treatments for prostate cancer are radiation therapy and surgery.
Dr. James Brooks explains active surveillance
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.
What Does Active Surveillance Entail?
The active surveillance approach usually involves a PSA test every 6 months, repeat digital rectal examinations no more frequently than every year, and 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.
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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.
Dr. Stephen Freedland, a urologist at Cedars-Sinai Medical Center tells SurvivorNet, “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.”
When is active surveillance not enough?
However, Dr. James Brooks, chief of urologic oncology at Stanford Medicine, tells SurvivorNet that about 50% of men who opt for active surveillance “will have changes within five years that require active treatment.”
This is why the topic is of such debate in the medical world. Many more of these cancers are being found because of increased screening. There’s a real question about how dangerous these cancers are and whether they should be treated.
Every treatment or nontreatment comes with its own set of risks and benefits. The same is true of active surveillance. This approach is generally not recommended for men with high- or intermediate-risk prostate cancer. It also might not be ideal for men who would feel extremely anxious about having cancer and not treating it. It’s a very individual choice you should discuss with your doctor.
Prostate Cancer Symptoms & Diagnosis
Prostate cancer begins in the walnut-shaped prostate gland, which is located between the rectum and bladder and produces the fluid that nourishes sperm. Routine screening can help detect this cancer. Prostate cancer can behave differently from one man to another.
After a screening, which as we mentioned above consists of a prostate-specific antigen (PSA) blood test (PSA is a protein produced by both noncancerous and cancerous tissue in the prostate), a risk assessment helps doctors determine how to move forward with possible treatment.
Again, men may be considered “low-risk,” which means the cancer can be slow-growing and treatment might not be necessary. On the other end of the spectrum, men at higher risk could have cancer that grows faster or have more aggressive cancer requiring treatment. Screening should start between 40 and 50 years old, depending on risk level and family history, which you can discuss with your doctor.
Some warning signs for prostate cancer are include:
- Blood in your urine
- Trouble getting an erection
- Pain or burning when you urinate
- Pain in your back, hips, thighs, or other bones
- Unexplained weight loss
- Fatigue
Questions to Ask 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?
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