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Prostate and Urological Health

Why Less Is More When It Comes to Treating Prostate Cancer

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James Mohler, M.D.

Roswell Park Comprehensive Cancer Center, NCCN Guidelines® for Prostate Cancer

Prostate cancer is the most common cancer in men — but most men who get it won’t die from it.

That means that not every person diagnosed with prostate cancer should treat it. Keep that in mind, especially if you are told you have low-risk prostate cancer. You may be anxious to have the cancer removed as soon as possible, but treatment comes with significant side effects, so take the time to weigh your options carefully.

Studies reveal that many cases of low-risk prostate cancer are over-treated in the United States, leaving men to deal with significant side effects for the rest of their lives. Standard treatments for prostate cancer include surgery to remove the prostate or radiation to destroy the tumor. Both can cause erectile dysfunction and urinary incontinence.

Keep an eye on it

For most men with low-risk prostate cancer, there is another option — active surveillance, or monitoring the disease carefully instead of starting treatment right away.

During active surveillance, your doctor will probably recommend a yearly prostate exam, as well as a blood test every six to 12 months to keep an eye on your level of prostate-specific antigen (PSA). A rising PSA level may mean your cancer is becoming more aggressive. In some cases, an MRI or biopsy might also be performed during active surveillance to provide additional information about the cancer.

If at any point these tests indicate your cancer is becoming aggressive, you and your doctor may decide it’s time to begin active treatment. This happens with about 1 in 3 patients.

Delaying treatment

Research shows it’s safe to delay treatment for low-risk prostate cancer while monitoring the disease. A University of California, San Francisco study of 157 men, who underwent surgery after a period of time on active surveillance, found their survival rates were similar to those who had surgery immediately after they found out they had prostate cancer.

An even larger study at Johns Hopkins University involved 1,298 men with prostate cancer. It revealed that 10 years after choosing active surveillance, only 0.1 percent of the men involved died of cancer and only 0.6 percent had cancer that metastasized, or spread to other parts of the body.

Only half the men went on to active treatment after starting out on active surveillance. On average, the time from their diagnosis until they began active treatment was eight and a half years — eight and a half years without having to endure the side effects of treatment.

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In the National Comprehensive Cancer Network® (NCCN®) Guidelines for Prostate Cancer v1.2010 (published in December of 2009), the NCCN® advised that virtually all men with low-risk prostate cancer should be offered active surveillance as an option, and, in many of those cases, it should be the only treatment recommended.

Unfortunately, some physicians do not inform their low-risk patients about this option, or strongly advise them to move ahead with surgery or radiation. If you are told you have low-risk prostate cancer but your doctor does not mention active surveillance, or discourages you from considering that option, it’s time to get a second opinion.

Questions you should ask your care provider:

  • Is my prostate cancer considered high-risk, low-risk or somewhere in between?
  • Based on my overall health, how concerned should I be about my cancer progressing?
  • Am I a good candidate for active surveillance?
  • How do you plan to monitor my cancer, and what kind of testing will be involved?
  • What are the risks and benefits of treating my cancer now?

For more information about prostate cancer and its treatment, including active surveillance, visit the NCCN website.

James Mohler, M.D., Roswell Park Comprehensive Cancer Center, NCCN Guidelines® for Prostate Cancer, [email protected]

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