Yes, Active Surveillance Is a Treatment
Last updated: September 2023
Over the past several years (10 to be exact) I have coached countless men who are either concerned about a recent prostate cancer diagnosis or who are experiencing the impact of their diagnosis. Most often I encounter folks when they attend one of our "open to the public" education and support meetings.
Typically, the men are accompanied by a partner, a family member, or a significant other. I have noticed that the majority of newly diagnosed men, when they join in, will at some point bravely announce they want to schedule treatment as soon as possible. For the most part they have focused on a direction and are not open to discussing or considering a course of treatment called active surveillance.
I believe this happens because most people do not understand that prostate cancer may not be an urgent or life-threatening disease. At some point during the meeting one of us would suggest they consider getting a second or third opinion if they had only met with 1 provider and to also discuss the various options with members of the family.1
Considering the options and risks
When men are diagnosed early on and with a localized low-risk prostate cancer, the risk of dying from this disease can be rather low. The challenge, as I see it, is trying to explain to men that they don't have to immediately jump into surgery or any form of treatment that can cause some issues, either immediately or in a few years.1
For example, if they undergo surgery, men can immediately have issues with urinary incontinence and sexual performance. In time those issues may resolve to a somewhat normal state, but things may also never be the same. Should they choose radiation, it can impact their sexual life as well as urinary control and more over a period of time.2,3
It can seem counterintuitive
If someone is diagnosed with a low-grade cancer it might be wise to consider active surveillance even though the thought of delaying treatment may appear to be counterintuitive - especially after hearing the words "you have cancer."
In my opinion, a good course of action for men is to make it a point to get regular examinations and to undergo PSA testing and a digital exam on a regular basis. While surgery and radiation can cause remission or slow down prostate cancer, there can be many side effects, sexually and rectally, that over time can impact quality of life.
Get a second opinion
If you are a candidate for active surveillance, it can be good to take a deep breath and consider what your doctor is saying. At the same time, I would also suggest that if you are being recommended for active surveillance you consult with an additional physician to get a confirming opinion rather than trusting a single physician's recommendation.
You can always make a decision to get treated when you are on active surveillance but in the meantime, you have delayed the start of other treatments. If you pursue this treatment option and are not sure you are going down the right path ask yourself one question: "Why should I undergo life-changing treatments before I really need to take that step?"
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