Is Active Surveillance the Right Choice?
Active surveillance is being recommended with greater frequency today for men with low-risk prostate cancer and even for some who are at intermediate risk.
Advantages of active surveillance
The advantage of active surveillance, at least in the beginning of your prostate cancer journey, can help you to avoid the negative urinary, sexual and rectal side effects that often follow treatments with surgery and/or radiation.
If you're on active surveillance and discover that your cancer is progressing, you can decide along with your medical team to continue watching or undergo some type of direct treatment option.
While research suggests that active surveillance is effective for a select group of patients, studies now indicate that a significant number of men are not following the guidelines and may be putting themselves at risk for undetected advancing cancer.1
Doctor Eric Klein of the Cleveland Clinic pointed out in 2019 that patients really need to be monitored very closely if they are utilizing active surveillance as a treatment option.2
No one-size-fits-all formula
Adding more confusion to the mix is there is no national or international consensus on what makes up an ideal strategy when it comes to men and active surveillance.2 No one knows, for example, how many blood tests a patient needs, or precisely how many rectal examinations should be done over a time period. No one knows how often a man should undergo a prostate biopsy.
Add into the mix that every man is different when it comes to how prostate cancer impacts him. How aggressive is the cancer? What are the individual characteristics found in a specific patient? In short, there is no “one-size formula” that fits all when it comes to active surveillance protocols.
A study that was presented at the American Society of Clinical Oncology's annual meeting in June of 2019 noted that only a third of men adhere closely to the recommended guidelines of monitoring when using active surveillance.1,2 Men typically do not like to visit with doctors, and because early stage prostate cancer often shows few to no symptoms, it is easy for guys to just ignore the whole issue.
Not for everyone
Active surveillance is not right for everyone. Apparently to be effective, your MD has to be sure you have the right type of tumor and, somehow, determine if you have the right mindset.
For many men, it can be difficult to know they are living with diagnosed untreated cancer. Over time, the stress simply becomes overwhelming. I'm personally aware of a man who after five years of active surveillance simply couldn't take it anymore and decided to have his prostate removed.
In addition to the stress caused by repeated biopsies, there is always a small risk of infection along with the associated pain, apprehension and discomfort associated with the never-ending scheduled biopsies.
While we think of active surveillance with newly diagnosed patients, it is not necessarily the only application. Following my combination treatment of surgery and then radiation 5 years later, I find myself on a form of active surveillance. I am checked by my urologist annually, and then six months later by my radiation oncologist annually, to see if my cancer is returning or remains in remission.
No matter how you look at it, active surveillance at any stage causes significant stress for patient and physician alike.
Do you feel heard and understood by your doctor?