Active Surveillance For Prostate Cancer
  Many Prostate Cancer Patients Can Safely Avoid Treatment

Recent articles from our practice newsletter, Alliance Answers, have highlighted state-of-the-art prostate cancer treatments such as robotic prostatectomy and cryotherapy. These treatments have continually produced favorable outcomes in patients with advanced prostate cancer. However, in cases of low risk prostate cancers, it may actually be better to carefully monitor the cancer rather than moving immediately to active treatment. In fact, early data suggests that certain select patients with low risk disease are excellent candidates for an active surveillance protocol that can help them avoid the risks of active treatment without compromising survival or cancer outcomes.*

Occurrence Rate Of Prostate Cancer
Prostate cancer is the most common cancer affecting men in this country (excluding skin cancer) and is the second leading cause of cancer death in men. Despite these dire statistics, the majority of men diagnosed with prostate cancer do not die of this disease. Recent studies suggest that 30 to 50% of men over the age of 60 who are diagnosed with prostate cancer by prostate-specific antigen (PSA) screening, never would have known they had prostate cancer during their life if a prostate biopsy had not been performed.

Cancer aggressiveness can be predicted to some degree using existing clinical parameters. Many prostate cancers can be classified as low-risk. These tumors generally are very slow growing and in certain situations can be safely monitored rather than treated immediately. Active surveillance is used by Alliance Urology Specialists to carefully observe appropriate patients with lower risk prostate cancer in hopes of being able to avoid over treatment and the risks that come with active therapy.

Factors that determine recommendation for active surveillance include:

  • Patient age and health
  • PSA levels
  • Changes in the PSA values over time
  • Biopsy results (Gleason score and amount of
  • cancer present in the biopsy material)
  • The patient’s comfort level with treatment
  • options versus the surveillance approach
In general, patients being considered for active surveillance should have slowly rising PSA levels that are less than ten and low volume Gleason score of 6 or less for cancer on their biopsies.

Active surveillance requires continued and consistent patient care to monitor the status of the cancer. Treatment can then be pursued if changes occur which indicate a more aggressive tumor. The typical active surveillance regimen includes a PSA and rectal exam every three months and periodic repeat biopsies (usually 6-12 months after the initial biopsy and then every two years thereafter). If changes are noted that suggest that the cancer may be more clinically significant, treatment options are discussed and recommendations are made. Active treatment can include radical prostatectomy, radiation therapy with external beam or brachytherapy (seed implantation), or cyrotherapy.

“There is no doubt that many prostate cancers are over-treated,” said practice urologist David Grapey, MD, FACS. “Some patients would be better treated with no treatment at all. That’s why we carefully assess each individual and recommend what we believe is in his
best interest.”

For more information about treatment of prostate cancer, call 336-274-1114.

*Cancer. 2008 June 15, 112(12) 2664-70.

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