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Prostate Cancer: When Active Surveillance Wins Out Over Immediate Treatment

The word “cancer” strikes fear in everyone who is told they have it. It conjures up images of a fast-moving, life-threatening disease.

That isn’t necessarily the case for men with newly diagnosed prostate cancer. More than half of them have a type of cancer that is confined to the prostate gland and that grows so slowly it will never affect their health or their lives. Yet almost 90% of men told they have prostate cancer opt for immediate treatment with surgery or radiation therapy—which often cause trouble getting or keeping an erection and an assortment of urinary problems.

Two weeks ago, a panel of experts convened by the National Institutes of Health recommended that many men with localized, low-risk prostate cancer be closely monitored, and that treatment be delayed until there was evidence that the disease was progressing.

“It’s clear that many men would benefit from delaying treatment,” Dr. Patricia A. Ganz, conference panel chairperson and director of the Division of Cancer Prevention and Control Research at the Jonsson Comprehensive Cancer Center at the University of California in Los Angeles, said in a statement, adding that there isn’t yet a consensus on the best way to follow men pursuing this strategy or when to begin treatment.

An alternative strategy to immediate treatment is something called “active surveillance.” A man with early, localized prostate cancer who chooses this would have his prostate-specific antigen (PSA, a measure of prostate cancer growth) checked routinely and may also have repeat biopsies of the prostate. Both help to detect if a slow-growing prostate cancer begins to become aggressive.  (You can read the panel’s full report here.)

Prostate cancer is different

If lung cancer is like a fast-moving wildfire, prostate cancer is like a slow-moving sloth. About 30% of men over age 50, and about 70% of men over age 70, have at least some cancerous cells in their prostate glands. Yet most of them die from something else, and never know about these cells.

The development of the PSA test changed that. This test, which detects the presence of cancerous prostate cells, can’t tell the difference between ones that pose no threat to health from those that will. Today, almost 90% of prostate cancers are detected from blood tests in healthy men.

Finding cancer early and treating it as soon as possible is a good thing for lung cancer, breast cancer, and other rapidly growing cancers. But it isn’t for most prostate cancers. In fact, a minority of men with low-grade prostate cancer will benefit from early diagnosis and aggressive treatment.

The NIH panel estimates that 100,000 American men each year could safely avoid treatment for a while, or possibly forever, with active surveillance. This means that they can put off, or never encounter, side effects of prostate cancer treatment such as impotence and loss of control over urinary function.

Going forward

One thing that might make a big difference is finding a new name for the condition we now call low-grade prostate cancer. It could alleviate some of the mental stress that comes with a diagnosis of cancer, and a feeling that you need to do something right away.

Another thing that will help is a more thoughtful approach to PSA screening. It may have detected many cases of prostate cancer over the years, but it has also contributed to unnecessary treatment for hundreds of thousands of men.

The recommendations from the NIH panel should be encouraging to all men with low-grade prostate cancer. The bottom line is that you don’t need to rush to treatment. Take time to carefully consider your options. If you want to have your prostate cancer treated, explore your options and choose the one that feels right to you. Or you can wait to see if the cancer stays in the background. If it does, great. If not, you can opt to start treatment then.

You can read Dr. LeWine’s bio here.

*This blog post was originally published at Harvard Health Blog*

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