Q: I recently had a prostate biopsy, which showed a small area of cancer in one of the biopsies.
My urologist discussed the option of close surveillance, with periodic biopsies and regular PSA blood testing.
I'm 65 years old and otherwise in great health. Do you think it's better to treat the cancer or just watch it?
A: In the case of early prostate cancer like you have, active surveillance is certainly a reasonable approach.
The downsides to it are the uncertainty of the prostate cancer's disease course and the anxiety of living with prostate cancer. Even though treatments like nerve sparing prostate surgery, prostate radiation seeding and freezing have a lower risk of incontinence and impotence than the older traditional radical prostate removal procedure, there's still a risk of causing more harm than if the doctor watched an early prostate cancer closely and intervened as necessary.
A recent Swedish study published in the journal European Urology supports the active surveillance approach. They analyzed 968 men (median age 65.4 years) diagnosed with prostate cancer — 440 of whom agreed to use active surveillance as their treatment strategy.
Most of those men had low risk tumors, but there were some men with intermediate or high risk tumors. Sixty of the 440 subjects who underwent active surveillance eventually died, but only one death was caused by prostate cancer. Sixty-three percent of the men kept using active surveillance for the rest of the follow-up period (up to 15 years). None of the low risk patients developed metastatic prostate cancer or died from the disease. Four men decided to stop active surveillance and get treatment due to cancer anxiety.
That said, for younger patients and/or folks with more advanced cancer than you, active surveillance may not be the best option.
A recent Swedish study published in the journal European Urology supports the active surveillance approach. They analyzed 968 men (median age 65.4 years) diagnosed with prostate cancer — 440 of whom agreed to use active surveillance as their treatment
Dr. Mitchell Hecht is a physician specializing in internal medicine. Send questions to him at: Ask Dr. H, P.O. Box 767787, Atlanta, GA 30076. Due to the large volume of mail received, personal replies are not possible. — S.L., West Palm Beach, Fla.