Active Surveillance for Prostate Cancer

Before you say ‘yes’ to treatment…

A diagnosis of prostate cancer can cause great anxiety. Many patients feel the cancer should be treated right away.

However, not all cases of prostate cancer need to be treated. Many people with prostate cancer are eligible for active surveillance, which means monitoring the disease carefully instead of starting treatment immediately. Your doctor may offer you this choice if:

  • You have early-stage prostate cancer that seems to be growing slowly or not at all.
  • Your Gleason score is 6 or less, and your doctor cannot feel the tumor during digital rectal examination.
  • You are older (will probably live less than 20 more years) or have other health problems.

Studies show that it is safe for those with low-risk prostate cancer to delay treatment. In fact, in 2009 the National Comprehensive Cancer Network advised that virtually all people with low-risk prostate cancer should be offered active surveillance as an alternative to treatment, and in many of those cases, it should be the only treatment recommended.

Delaying the side effects of treatment

Why not remove the cancer anyway? Prostate cancer treatment is associated with significant side effects, including incontinence (inability to hold urine) and erectile dysfunction (inability to get or maintain an erection). Studies have shown that many cases of low-risk prostate cancer are over-treated in the U.S., leaving those to deal with side effects for the rest of their lives. Delaying treatment means extending the amount of time that you won’t have to live with those possible side effects.

Unfortunately, some physicians do not inform their low-risk patients about active surveillance, or pressure 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. To arrange for a second opinion, call 1-800-ROSWELL (1-800-767-9355) or fill out the online Become a Patient form.

What if things change?

If the disease changes and becomes more aggressive while you are on active surveillance, you and your doctor may decide that it’s time to begin treatment. This happens with about one in three patients. You will still have time to learn about all your options and make careful choices before treatment begins. Delaying treatment while you are on active surveillance is not likely to reduce the chance of a cure.

If you do need to begin treatment, now or in the future, Roswell Park’s Prostate team will make sure you’re informed about all the possible treatments that are right for you.

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