Last updated: August 2022
If you have been diagnosed with low-risk prostate cancer, chances are good that you may be able to take advantage of something called active surveillance. A low-risk cancer is one that scores below 6 on the Gleason scale. It is typically confined to the prostate and, based on testing, is unlikely to grow or spread in the immediate future.
For those of you who are not familiar with the term active surveillance, it is a monitoring process that often involves using a blood test to check the Prostate Specific Androgen (PSA) levels in your bloodstream at somewhat regular intervals along with a digital rectal exam. The surveillance process is typically scheduled every six months, with a digital rectal exam (DRE) potentially once a year.
Keeping up with appointments
Depending on your physician, you may also be asked to undergo an MRI scan. You may also be asked to undergo additional biopsies should evidence suggest that your cancer is spreading or becoming more aggressive.
While there is no magic rule that determines when a watched cancer should be treated, it is wise to keep current with active surveillance appointments. Prostate cancer often does not show early warning symptoms, and it will not go away on its own. It can get worse. Silence is not a cure when it comes to prostate cancer.
Tools for active surveillance
I think there have been (some say exciting) breakthroughs in helping men decide on how they should proceed with active surveillance.
Two advanced online calculators have been developed as part of the Prostate Active Surveillance Study (PASS). When properly used, these tools can help you and your physician estimate the potential aggressiveness of cancer and consider possible next steps.
One way to use these calculators is to have had a biopsy and understand what the findings mean. The more history (testing) you can draw upon, the more the calculators can try to give you and your MD a better indication of what your future might look like with prostate cancer.
What the calculators take into account
The calculators use the results of past biopsies along with other measurements such as PSA levels, the age of the patient, prostate volume, and the time of the first prostate cancer diagnosis.
As with all things in life, nothing is ever 100% perfect; that said, the calculators can help a man and his doctor decide if another biopsy is needed or if it's time to consider some form of prostate cancer treatment.
Helping offer treatment alternatives
An online study published in 2020 by American Medical Association (JAMA) Oncology found that the calculators helped MDs to be better informed when offering different treatment alternatives to men, which in turn can hopefully result in fewer biopsies and less anxiety for patients.
Active surveillance is not a treatment. Rather, it is a tracking procedure that allows you and your MD to watch and measure any progression. The fact that you are on active surveillance does not mean that your cancer will not become more aggressive over time. Active surveillance simply gives you a way to keep unnecessary treatment options at bay until a time when they are needed.
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