A diagnosis of prostate cancer can cause great anxiety. Many patients feel the cancer should be treated right away.
However, not all prostate cancers 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.
Who should consider active surveillance?
Your doctor may offer you this choice if:
- You have early-stage, low-risk, or favorable-intermediate-risk prostate cancer that seems to be growing slowly or not at all.
- Have a PSA level under 10
- Your Gleason score is 6 or 7 (3+4)
- You are older (will probably live less than 20 more years) or have other health problems.
- You want to preserve your sexual and urinary function
Why not remove the prostate anyway?
Prostate cancer treatments like surgery and radiation can have 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 patients to deal with side effects for the rest of their lives. Delaying or avoiding surgery and radiation means extending the amount of time that you won’t have to live with those possible side effects, without affecting survival.
What does active surveillance for prostate cancer involve?
This approach does not mean you do nothing. While you do not receive cancer treatment, you will be monitored by our expert team at regular intervals to discern whether anything about your health or your cancer has changed that will trigger further evaluation and possibly treatment. Most studies show that delaying treatment after a period of surveillance does not compromise survival.
Your specific surveillance plan will be personalized for you, but in general, it may include:
- PSA test twice a year
- Digital rectal exam once a year
- MRI scan every 1 to 2 years
- Repeat prostate biopsy as needed
When do I switch to treatment?
If your cancer grows larger and becomes more aggressive, you and your doctor may decide that it’s time to begin treatment. This happens with about one in three patients. Your doctor may suggest it’s time to consider treatment if you have:
- Rapid increase in your PSA level, or PSA greater than 10
- A change, or new nodule found during digital rectal exam
- MRI scan that shows disease progression
- A biopsy finds the tumor has grown larger or has a worsening Gleason score
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.
Studies show that it is safe for those with low-risk or favorable intermediate-risk prostate cancer to delay treatment. In fact, the National Comprehensive Cancer Network, the governing organization that creates the treatment guidelines used around the world, advises that most 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 preferred treatment recommended.
If you try active surveillance and decide that you are not comfortable with monitoring your cancer, ask your care team about other treatment options that might be right for you, such as surgery, radiation, or focal therapy with High-Intensity Focused Ultrasound (HIFU).
HIFU is new type of treatment uses ultrasound waves to treat only the cancerous part of the prostate gland, rather than the entire prostate and has a lower risk of side effects than surgery or radiation. A noninvasive option, patients typically go home the same day.