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Prostate Cancer: What is ‘Active Surveillance’?
November 06, 2018
While it may seem passive, the “active surveillance” approach to treating prostate cancer requires a diligent monitoring process.
Dr. Stuart Kesler, a urologist with the Hartford HealthCare Tallwood Urology & Kidney Institute, says that even when prostate cancer is discovered, there isn’t always a need to start treatment immediately. Often, the disease is localized, meaning it is only in the prostate and hasn’t spread to other parts of the body. And, for many men, it doesn’t come with symptoms or related problems at first, and sometimes never causes symptoms.
“We know that many treatments for prostate cancer, including radiation or surgery,” says Dr. Kesler, “can cause significant side effects, so we believe that if the cancer is not considered high risk to spread or cause death, we might not have to treat it immediately.”
Tests can reveal if the prostate cancer is low-, medium- or high-risk, indicating the chance that it will grow or spread. Whatever the risk level, the disease does need to be monitored. Men with low-, and sometimes even medium-risk prostate cancer, Dr. Kesler says, can use “active surveillance” knowing that if concerning changes are found, treatment can begin.
“Some prostate cancers are slow growing and may never cause the man any problems,” he says. “Other times, the cancer is at higher risk to progress and then we will discuss treatment options.”
Symptoms both patient and doctor look for include:
- Trouble urinating or urinary retention.
- Increased need to urinate.
- Decreased flow during urination.
- Trouble starting or stopping the urine stream.
- Blood in semen.
- Bone pain.
Dr. Kesler notes that having one or more of these symptoms does not automatically mean you have prostate cancer since an enlarging, non-cancerous prostate and other diagnoses can also cause some symptoms.
During the surveillance period, a doctor monitors your health with regular tests such as:
- Digital rectal exam to feel the surface of the prostate for bumps that could be tumors.
- Prostate specific antigen (PSA) test to monitor the level of the PSA protein in your blood.
- Imaging test such as magnetic resonance imaging (MRI) and ultrasound to see if the disease has spread beyond your prostate.
- Biopsy of the prostate.
- Surveillance must be done judiciously, however, because delaying treatment too long can sometimes limit your options.
“We usually recommend this approach to younger patients with fewer health conditions such as heart disease or diabetes,” says Dr. Kesler, adding that, “Research has shown that men who have low-risk, localized prostate cancer can fare just as well on active surveillance as other men who opt for treatment.”
For more information on treatment for prostate cancer, talk to your primary care physician or click here for more information about the Tallwood Urology & Kidney Institute.