For 15 to 20 years, some among the prostate cancer community (including the current author) have continuously argued that some form of careful patient monitoring (call it watchful waiting; call it active surveillance; call it what you will) is a better management option than aggressive and invasive treatment for carefully identified patients believed to have low risk forms of disease.
In a well-structured and carefully written editorial in the Journal of Clinical Oncology, Zeitman has now defined the very fundamentals of the argument in favor of active surveillance (AS) for a large percentage of newly diagnosed patients — and he calls on his colleagues in the urologic oncology and radiation oncology communities to rethink their motivations and their behaviors with regard to the management of the newly diagnosed patient.
The “New” Prostate Cancer InfoLink applauds Dr. Zeitman for this editorial, which every prostate cancer advocate and every physician who is responsible for the management of a newly diagnosed prostate cancer patient should read with care — at least twice!
HOWEVER, we also would point out that this application of AS is utterly dependent on the current and continuing use of the PSA test (for lack of anything better) to identify patients with early stage prostate cancer and monitor them accordingly over time. Do we need a better test that can discriminate the patient with indolent disease for the patient with aggressive Gleason 6 prostate cancer? Of course we do. But in the meantime we need to follow the data published last week by Grace Lu-Yao and her colleagues, which clearly demonstrates that PSA testing has massively reduced the risk of an initial diagnosis of progressive, regionally advanced disease, by which time the patient is quite certainly at high risk for metastatic prostate cancer which might have been avoided.
The “New” Prostate Cancer InfoLink calls upon the prostate cancer advocacy community to accept the realities of over-treatment, and to start to become advocates for a more humane and conservative approach to the management of localized prostate cancer, in which the goal is to manage all of the patient’s risks with equal sensitivity, and not to just substitute one set of risks (for metastatic prostate cancer) with another (for impotence, incontinence, and other side effects of aggressive early therapy).
Filed under: Diagnosis, Living with Prostate Cancer, Management, Risk, Treatment Tagged: | active surveillance, localized, risk, Treatment
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I am doing AS as a Gleason 6 (3 + 3), 6 specimen biopsy. I was offered aggressive treatment, but with no feel (DRE) and no see (Ultraimage) I decided to do AS until more information is available. I am 64 (65 in February) and believe I will die from something else first. When (and if) that picture changes I’m sure my Uro guy will let me know. I had a bout with Melanoma 10 years ago so I understand the risk. Something WILL get you in the end.
An excellent article. When I compare the poor quality of life I have had to endure the last two years due to aggressive treatment that 4 doctors recommended I cringe in sadness, especially for older patients who have other health issues. It is wrong to put them through additional pain and bad side effects. There has got to be a better way!
I’ve been on AS now for a little over a year and intend to stay with AS as long as my PSA stays down. Mine is a Gleason 3 + 3, graded T1c, PSA presently 4.01. I’ve read about 200 cases of prostate cancer in the past 6 months and believe far too many men get aggressive treatment when AS would have given them better quality of life without too much risk.
I am 75 with a life expectancy of 93.
I believe that AS is more than just watching your PSA with annual DRE and checkup. You need to investigate treatments and read articles about prostate cancer. I further believe you are what you eat and I have change my diet considerably. I recently heard Dr. Snuffy Myers say that the genetic disposition for prostate cancer is more about what you learned to eat in your family than anything else.
You can see what I am doing in AS on this website link.