Is Active Surveillance Right for You?

Is active treatment a good treatment option for some men with prostate cancer?

active surveillancePatients electing active surveillance for prostate cancer has become commonplace in the United States in recent years. Recent advances in technology have made what used to be an option for older men available for men of all ages who’s prostate cancer has been detected at an early enough stage. Though some cases are highly aggressive, many prostate cancers are slow-growing and may not effect a man’s health for a very long time, if ever.

Dr. Richard Bevan-Thomas explains that by performing follow-up biopsies and monitoring PSA levels, doctors can tell if and when the cancer become more active or more aggressive. If the cancer does, doctors will immediately begin a more aggressive treatment. For more, watch the video below:

Video Transcripts

Richard Bevan-Thomas, MD: Active surveillance is a way in which we can follow patients with low-grade prostate cancer. It sounds crazy. You’ve got prostate cancer and we’re not going to treat it. However, what we do know now is that there are several men, and a significant percentage of men that actually have such a slow-growing prostate cancer that we don’t need to be overly aggressive in the early phases. But, don’t be mislead. We’re not leaving you out forever. We follow you, and that’s why it’s called surveillance. We surveill you, forever, basically.

And the way that we do this is we do two things. Number one, we’re going to follow the PSA. The PSA is helpful for us because as that PSA rises up there is a higher potential that the cancer inside of the prostate is starting to grow. The second thing we do is repeat biopsies, which I know is the most favorite thing that patients love having done. Nonetheless, we want to make sure that we are actually following that cancer to make sure that we are not seeing a higher grade of that cancer or a higher volume of that cancer. If we see a higher grade or a higher volume of that cancer at that point, we then change routes and pathways and recommend a more aggressive intervention than that. But this has come about because we know that these lower-grade prostate cancers are actually growing very slowly.

It originally started with men in their seventies and now we find men of all ages that we are following very closely. As long as we continue to follow men with a low-grade prostate cancer with their PSAs and routinely we’ll get a PSA every three months. We’ll see the patients back twice a year. At six months routinely we’ll do a rectal exam to make sure we are not seeing any changes on the rectal exam or the physical exam. And then repeat a biopsy. So again the biopsy is going to be done at years one, years three, and years five. And then every two to three years thereafter.

The biopsy, unfortunately for the patient, is the most important thing that we have that lets us know whether there is more cancer present or whether that cancer has started to grow. If we see that, at that point we change avenues. And that avenue is then going to be an avenue where we say we see we have seen a higher grade cancer, we see higher volume. We need to now consider treatment. The underlying goal on active surveillance is we don’t want to overtreat. But, we also don’t want to undertreat. Because if we let a cancer continue to grow and it gets outside of the prostate and it gets beyond the confines of the prostate, now we’re in trouble.

So there’s a fine line there and we are going to be following it very, very closely to make sure that we don’t miss that. There are always risks of this but as long as we are following the PSA as well as the follow-up biopsies the chances that we are going to be missing a high-grade or high-volume cancer that is going to get outside of the prostate is extremely low.

Dr. Richard Bevan-Thomas
Dr. Bevan-Thomas is the Medical Director for Prostate Cancer Live. A graduate of Duke University, Rich received both a master’s degree in anatomy and his medical degree from St. Louis University School of Medicine. He completed residency training in urologic surgery at the University of Texas Houston Health Science Center and the renowned MD Anderson Cancer Center, also in Houston. In 2002, he received two top honors in his field; the Pfizer Scholar in Urology and the Gerald G. Murphy Scholar in Urology. Dr. Bevan-Thomas will remain on the leading edge of robotic surgery and cryosurgery at USMD Prostate Cancer Center and will continue offering patients the latest clinical trials in prostate cancer treatment. He continues his teaching and physician proctoring interests as well as instructing in robotic surgery.


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