Active surveillance over prostate cancer treatment: Is it right for you?
More men are opting for active surveillance after a low-risk prostate cancer diagnosis. And while this watchful approach may sound passive, it can open the door for men to take a more active role in their overall wellness.
What is active surveillance?
Active surveillance is an option for men whose prostate cancer is considered low risk, judged by two factors: the cancer is confined to the prostate, and specific findings appear on a prostate biopsy. During a biopsy, the doctor typically takes 10 to 12 tissue samples. A pathologist examines them, confirms whether cancer is present, and assigns a Gleason score.
The Gleason system ranks the two most common types of cancer cells in the samples on a scale of 1 to 5, then adds the two rankings together for a score out of 10. The higher the number, the more likely the cancer is to grow and spread quickly. A low Gleason score - usually a 6, sometimes a 7 - strongly suggests the cancer is unlikely to progress rapidly.
Men on active surveillance see their doctor regularly for PSA blood tests and digital rectal exams. The doctor may also order newer blood and urine tests, an MRI, or a repeat biopsy. If there is evidence the cancer has advanced - a rising PSA, new findings on other tests or on MRI, or a higher Gleason score on a repeat biopsy - then active treatment comes onto the table.
Why choose active surveillance?
The point of active surveillance is to postpone immediate surgery or radiation, since low-grade prostate cancer is unlikely to progress. That also means sidestepping the possible side effects of treatment, such as erectile dysfunction, urinary incontinence, and bowel problems.
Men with low-risk prostate cancer stand a good chance of living a long time, so it makes sense to make that life as healthy and high-quality as possible. Lifestyle changes - eating a Mediterranean-style or similarly healthy diet, exercising more, and losing excess weight - could improve the long-term cancer outlook while also guarding against other serious problems like heart attacks and strokes.
