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.
