Johns Hopkins Health Alert
The Case for Active Surveillance
When a prostate biopsy indicates cancer, you might think you have to choose a treatment quickly. But usually there's no need to rush. Prostate cancer typically is a slow-growing malignancy, and most of the time men have months to consider their options. In this Health Alert, Johns Hopkins explains why active surveillance can be the right choice for some men.
The standard treatment options for prostate cancer include active surveillance, radical prostatectomy, radiation therapy, and hormone treatment. With active surveillance, a man opts to have no immediate treatment but undergoes close monitoring for cancer progression. Today this treatment approach is most often recommended for men with low-grade cancers that are believed to be small volume, especially older men whose cancers are unlikely to become life threatening during their remaining years of life.
The goal of active surveillance is to avoid unnecessary treatment in men whose cancer is unlikely to become life threatening over the next 10-15 years. Fewer than 10% of men who are candidates for surveillance take advantage of this approach.
Understandably, many men can't tolerate the anxiety and uncertainty of leaving a cancer growing -- even very slowly -- in their body. But with close monitoring, active surveillance can be a good choice for some. That's especially true for older men whose predicted life expectancy makes it unlikely that their cancer will progress in their remaining years of life.
The significant upside to active surveillance is that it allows a man to maintain an excellent quality of life without the side effects of radiation therapy or radical prostatectomy. But the approach requires close monitoring for signs of progression. This includes regular digital rectal exams (DREs), PSA tests, and a prostate biopsy each year or at some regular interval.
Not all prostate cancer specialists endorse surveillance. But research indicates that with careful monitoring, it can be a safe approach for many older men. Results of a 12-year study reported in the Journal of the American Medical Association showed only a 0.5% difference in the number of prostate cancer deaths between men treated with radiation therapy or radical prostatectomy and those whose cancers were managed with active surveillance.
Posted in Prostate Disorders on June 11, 2009
Reviewed January 2011
Medical Disclaimer: This information is not intended to substitute for the advice of a physician. Click here for additional information: Johns Hopkins Health Alerts Disclaimer
Notify Me
Would you like us to inform you when we post new Prostate Disorders Health Alerts?
Comments
Health Alerts registered users may post comments and share experiences here at their own discretion. We regret that questions on individual health concerns to the Johns Hopkins editors cannot be answered in this space.
The views expressed here do not constitute medical advice, and do not represent the position of Johns Hopkins Medicine or Remedy Health Media, LLC, which has no responsibility for any comments posted on this site.
I am 85 and now know that I have prostate cancer only through PSA and through Free PSA. We did not want to take any tratment or further examination like Biopsy. Both my parents died at the age of 90 or 91.Father had no complications of any kind excpt Glucoma in the eyes. Mother also was weak with age and died with weak heart.
Jayant H. shah
Posted by: Jayant H Shah | June 14, 2009 12:35 AM
Please donot mention my name in your Blog or news on cancer. Jayant H. shah
Posted by: Jayant H Shah | June 14, 2009 12:39 AM
65+ with slow PSA rise are safe to do Watchful Waiting, but Younger men die much faster. My DRE and ultrasound were OK at 43, but the PSA doubling time was 24 months and the free PSA was far below the normal 25% at 13%. The biopsy confirmed cancer at age 43 with 0.01 cm margins. The surgeon said if I had kept that prostate 2 more weeks I would have been incurable and dead in 2 years!
Posted by: tetech | June 14, 2009 1:07 AM
Post a Comment
Already a subscriber?
Login
New to Johns Hopkins Health Alerts?
What qualifies me as "an older man?" What if my goal is to live to be 100?
Posted by: Wooof100 | June 12, 2009 12:03 AM