When Brent Acton was diagnosed with prostate cancer 10 years ago, he assumed the first step would be surgery or radiation. After all, that's the step his father took to treat his prostate cancer. But Brent's physician recommended a different approach: active surveillance.
Because Brent has low-risk prostate cancer, active surveillance lets him closely watch for changes. “Not all cancers are created equal," says
Anish Shah, MD, urologist for The Christ Hospital Physicians. “Some cancers are slow growing and won't require immediate treatment – or perhaps any treatment – during a person's lifetime."
Men often choose active surveillance to delay or avoid more intense treatments that may not be needed. Radiation and surgery both effectively eliminate prostate cancer. But some patients experience side effects, including problems with urinary and sexual function.
Active surveillance tracks the progress of prostate cancer
Active surveillance monitors any growth changes or variations in the cancer without invasive medical intervention. Men can consider active surveillance if they have low-risk cancer.
Doctors rate your prostate cancer low risk if you have a PSA score of less than 10, a Gleason score of six and a normal prostate exam.
If the cancer stays low risk, you may continue active surveillance. But your doctor may recommend surgery or radiation if it grows or becomes higher risk.
Dr. Shah monitors the progress of his patients' prostate cancer through regular tests, including:
- PSA test: Done every three to six months, this simple blood test checks prostate-specific antigen levels.
- MRI: A doctor takes updated images a year after the diagnosis to see if there are any suspicious areas that require a biopsy to see if the cancer has changed over time.
- Biopsy: A year after the diagnosis, a tissue sample can verify if the cancer has grown larger or more aggressively. Your doctor uses this sample to give your cancer a Gleason score, which ranks risk.
After the first year, your doctor may repeat these tests periodically to monitor your cancer over time.
Brent's past decade on active surveillance
“I liked the idea of 'Don't do anything if you don't have to,'" says Brent. “I was confident because of the tests. You're still being treated and watched closely."
Brent didn't experience any physical disruption to his life from active surveillance other than mild discomfort from the biopsies. And any time he had a concern or question, his doctors quickly answered them or recommended a test to put his mind at ease.
Today, at 64 years old, Brent is still on active surveillance. His PSA has risen slightly over the years, but his MRIs, Gleason score and biopsies have stayed consistent.
“I'm not a person who loses sleep about this," says Brent. “With the regular treatment and testing, I know the cancer isn't spreading."
Today, more men are choosing active surveillance
The number of men choosing active surveillance is growing. A
recent study found that 60% of U.S. men with low-risk prostate cancer monitor their cancer instead of immediately treating it. This group has more than doubled between 2014 and 2021.
When discussing your treatment plan with your doctor, consider your overall health, confidence and comfort level. You can weigh the risks and benefits of immediate treatment like surgery or radiation compared to active surveillance.
Men choose active surveillance for their low-risk prostate cancer for several reasons, including:
The cancer may not grow or interfere with life: Some prostate cancers grow slowly and might not become a problem during a person's lifetime. Many men live with low-risk prostate cancer, monitoring it closely with their doctor. It doesn't interfere with their daily lives.
Urinary and sexual function stay intact: Radiation and surgery are very effective, though they come with a risk of erectile dysfunction and urinary incontinence. While these symptoms often improve with time and treatment, many men choose active surveillance as the less-invasive option.
Cancer changes are closely monitored: Active surveillance isn't “doing nothing." It's an active treatment plan that tracks how your cancer progresses over time. Using tests, your doctor will know if your cancer changes. At any point, you can revisit your treatment options.
A second opinion for your prostate cancer
Deciding how to treat your prostate cancer is personal. Getting another expert opinion can help you confidently make a choice.
Not sure if you should consider active surveillance or another treatment? A second opinion from experts at The Christ Hospital can help you put things into perspective.
“We always recommend second opinions for men who want them," says Dr. Shah. At our
Second Opinion Clinic for Prostate Cancer, you can get input from physicians in multiple specialties, including medical, radiation and surgical oncology.
Talk to your provider about men's health
Ask your primary care provider or urologist if you should get screened for prostate cancer. “We generally say men should get screened around age 50," says Dr. Shah. “If they have a family history of prostate cancer diagnosed at a younger age, they may benefit from screening sooner, for instance starting at age 45."
If you've got a question or concern about your health, Dr. Shah recommends asking your provider. “Men should feel like they can talk to us about any men's health issue. Erectile dysfunction, urinary incontinence, sexual function, enlarged prostate symptoms … who better to discuss these concerns with than your primary care provider or urologist?"
Find a primary care provider or urologist
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