Ask the Doctor at Saint John’s: Prostate Cancer Treatment Options

Q. What does ‘active surveillance’ mean as it relates to prostate cancer?

By Mark Kelly, M.D., board-certified urologist at Saint John’s Health Center.

Prostate cancer, a very prevalent condition, is diagnosed in more than 220,000 men each year in this country, but fewer than 40,000 of those men die of the disease. That’s because prostate cancer often is a slow-growing cancer that does not cause symptoms. Many men can live out their entire lives with prostate cancer without every experiencing disease or discomfort.

For those patients whose localized prostate cancer is felt to justify treatment, options include surgery, radiation therapy, hormone therapy, cryoablation (freezing), and high frequency ultrasound or HiFu (heat energy).

Active surveillance, also known as “watchful waiting” is an alternative to immediate treatment. It involves closely monitoring the cancer’s status through regular blood tests, rectal examination, and periodic biopsy.

Patients are encouraged to engage in healthy lifestyle behaviors – eating a nutritious diet, exercising regularly, reducing stress. Then instead of trying to destroy the cancer, with the potentially detrimental effects of treatment, your physician watches it closely. If any sign of progression develops, treatment can be given with no discernable detriment to the patient for having waited.

Age is the most common risk factor, with nearly 65 percent of prostate cancer cases occurring in men age 65 and older. Other risk factors for prostate cancer include family history, race and possibly diet. There is some evidence that a diet higher in fat, especially animal fat, may increase the risk of prostate cancer.

As men age, however, their statistical risk for harboring a prostate cancer increases to the point that if we were to perform biopsies on 80–year-old men, we’d find prostate cancer in virtually every one of them to some extent. The question is how many of these men could live the rest of their life healthy without having any symptoms or problems from that cancer?

There is compelling evidence that prostate cancer is over treated. Our ability to diagnose prostate cancer is well established. Using the PSA blood test, more men are diagnosed at an earlier stage of disease. However, it has been estimated that between 30 to 50 percent of men, whose prostate cancer was diagnosed solely by an abnormal PSA blood test, could have lived out their entire life never knowing they had prostate cancer.

Active surveillance could be the right choice for many. It spares patients from unnecessary treatments that can cause life-altering side effects, such as loss of sexual function, urinary incontinence, and rectal issues.

When a man is diagnosed with prostate cancer, the first question answered should be “What would happen if I do nothing?” Your urologist should be able to answer this question based upon your age and medical condition, as well as the grade, stage and various parameters used to measure the aggressiveness of your prostate’s cancer. Once this question has been addressed, the patient is now empowered to make clear decisions regarding his body and his health.

Mark Kelly, M.D., is a board-certified urologist at Saint John’s Health Center. For more information about Dr. Kelly and other Saint John’s services please call (310) 829-8990 or visit the website at www.stjohns.org. For a physician referral or a second opinion, please call 1-888-ASK-SJHC.

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