What Else Do You Need To Make Your Decision
Check the facts
- No, that’s not right. Some men will never need surgery or radiation. And others will be able to delay having surgery or radiation until tests show that their cancer is growing.
- Yes, that’s right. Some men will never need surgery or radiation. And others will be able to delay having surgery or radiation until tests show that their cancer is growing.
- It may help to go back and read “Get the Facts.” Some men will never need surgery or radiation. And others will be able to delay having surgery or radiation until tests show that their cancer is growing.
- You’re right. During active surveillance, your doctor will watch for any changes in the cancer. You will have frequent checkups and tests, such as PSA tests, digital rectal exams, and prostate biopsies.
- Sorry, that’s not right. During active surveillance, your doctor will watch for any changes in the cancer. You will have frequent checkups and tests, such as PSA tests, digital rectal exams, and prostate biopsies.
- It may help to go back and read “Get the Facts.” During active surveillance, your doctor will watch for any changes in the cancer. You will have frequent checkups and tests, such as PSA tests, digital rectal exams, and prostate biopsies.
- The side effects you might have from other treatments.
- Your personal feelings and concerns.
If you choose active surveillance, having a doctor who supports your choice is important. So is the support of others who are close to you.
Prostate Cancer: Watch And Wait Or Ignore And Wait
NEW YORK, NY
A long-term European study highlighted key patient compliance issues in the prostate cancer active surveillance strategy. In lieu of proactive prostate cancer treatments such as robotic prostate surgery, hormone therapy, or radiation, some men choose to postpone treatment and monitor the progression of their disease. Researchers found that one quarter of European men who chose to watch and wait failed to comply with follow-up testing, a critical component to long-term success, according to experts.
David B. Samadi, MD, Chairman of Urology and Chief of Robotic Surgery at Lenox Hill Hospital, perceives this pitfall as a major risk factor for prostate cancer survival. Active surveillance and watchful waiting are only viable options if patients understand the critical nature of screening compliance, said Dr. Samadi. So many men with prostate cancer are symptom-free and without frequent exams we have no way of preventing the disease from spreading.
Active surveillance involves undergoing regularly scheduled prostate-specific antigen blood tests, digital rectal exam physicals, and prostate biopsies and ultrasounds. As reported at the European Association of Urology annual meeting in Stockholm, 27 percent of active surveillance study participants abandoned their screening plans over the 13-year review period. Even at just three months post-diagnosis, 19 percent of the men refused to undergo a second prostate biopsy.
When Are These Options Used
One of these approaches might be recommended if your cancer:
- Isnt causing any symptoms
- Is expected to grow slowly
- Is just in the prostate
- Is associated with low PSA level
They are not likely to be good options if you have a fast-growing cancer or if the cancer is likely to have spread outside the prostate . Men who are young and healthy are less likely to be offered observation, out of concern that the cancer might become a problem over the next 20 or 30 years.
Observation and active surveillance are reasonable options for some men with slow-growing cancers because it is not known if treating the cancer with surgery or radiation will actually help them live longer. In active surveillance, only men whose cancer is growing are treated. For some men. these treatments have risks and side effects that may outweigh their benefits. Other men are not comfortable with observation or active surveillance because the cancer might grow and spread, limiting treatment options and the possibility of treating the cancer successfully. Some men accept the possible side effects of treatments to try to remove or destroy the cancer.
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So What Exactly Is Active Surveillance
Active surveillance means that instead of getting immediate treatment, a patient regularly visits his doctor for exams, prostate-specific antigen tests, and periodic prostate biopsies. Generally, the doctor repeats PSA blood tests about every 6 months. Also, digital rectal exams and prostate biopsies are done once every 12 months. With active surveillance, patients can avoid the potentially harmful side effects from treatments such as surgery, radiation therapy, and hormone therapy.
If a repeat biopsy shows that the cancer has spread to more prostate tissue or resulted in a higher biopsy Gleason score, then men who are on active surveillance may have to discuss new treatment options with their doctor.
Who Can Use Active Surveillance
Active surveillance may be an option if your cancer:
- Is only in your prostate
- Has a prostate-specific antigen level less than 10 ng/mL
- Has a Gleason score of 7 or less, which means your cancer is slow-growing. A pathologist will look closely at your tumor biopsy to get your Gleason score.
- Could be treated with surgery or radiation if it starts to grow
You must also:
- Not have any symptoms
- Feel OK about waiting to see if your cancer grows.
- Be able to go about your day-to-day life and not worry that your cancer will spread
- Understand the benefits and risks of your decision to follow active surveillance
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Active Surveillance And Watchful Waiting Are The Most Conservative And Increasingly Popular Approaches To Prostate Cancer Management Is One Of These Right For You
Over the years, the outcome for prostate cancer has turned out to be better than expected for many men.
While prostate cancer is quite common, the risk of dying from the disease is low, even without treatment. In fact, most diagnosed men will die from something else, like heart disease. Even so, prostate cancer remains the second leading cause of cancer deaths in men, according to the American Cancer Society.
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- Prepare for a doctor’s visit or test
- Find the best treatments and procedures for you
- Explore options for better nutrition and exercise
Good Candidates For Watchful Waiting And Active Surveillance
Watchful waiting is a reasonable approach for men with early-stage prostate cancer that seems to be slow growing, especially for men who are older than 65 or have other serious health problems. For these men, its not known whether surgery or radiation therapy will help them live longer. However, more research studies are necessary, comparing men of different ages and stages of cancer.
Active surveillance is also an option for small, slow-growing tumors. Treatment would begin if test results indicate a change in the tumor, or if you develop bothersome symptoms.
Both watchful waiting and active surveillance allow you to delay or avoid the side effects of surgery, radiation therapy, or other treatments. But it can be risky. Waiting to start treatment means that you may have less of a chance to control the disease if it becomes more aggressive. Waiting could also limit your treatment options.
Whether watchful waiting and active surveillance are safe options for you depends on these two main factors:
- Your Gleason score, which is the result of a lab test that analyzes the pattern of prostate cancer cells. The pattern determines the tumors likeliness to spread.
- Your tumor size and location, which you learn from the stage of prostate cancer. If its small and contained within the prostate, you may be a good candidate for waiting.
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Watchful Waiting For Prostate Cancer
If you have localized prostate cancer , you may choose to monitor your condition rather than seek immediate treatment. Watchful waiting is one form of expectant management for prostate cancer that may be effective for men with limited life expectancy and slow-growing, low-risk disease.
The Prostate Cancer Watch And Wait Approacha Harm Or A Help
D. Andrew Loblaw, MD, professor, department of radiation oncology, University of Toronto, and radiation oncologist, Sunnybrook Health Sciences Centre, Toronto, Canada. His study was presented at the 2015 Genitourinary Cancers Symposium in Orlando, Florida.
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If you or a loved one are sweating out the watch-and-wait approach that most men are subjected to when told they have prostate cancer, findings of a new study may either put you at ease or spur you to demand more from your doctor. The worldwide standard has been watch-and-wait for men who are considered to be at low risk for development of advanced prostate cancercancer that spreads beyond the prostate gland to nearby tissues, lymph nodes, bones or other parts of the body. Although this approach is also prescribed for many men considered to be at intermediate risk for advanced cancer, a debate has been ongoing among cancer specialists about whether that is appropriate or if it unnecessarily puts their lives in danger. A report recently presented at a major medical meeting of cancer specialists clears the air, and the information will be a decision-making boon if you are living with prostate cancer.
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How Is Watchful Waiting Different
Watchful waiting tends to be used for older men who are not expected to live for a long time. An example might be an elderly man who has localized, low-risk prostate cancer and other chronic and potentially life-threatening illnesses. In cases like this, the doctor doesnt treat the cancer. Instead, the focus is on managing the illnesses that pose an immediate threat to life and quality of life. Patients who choose watchful waiting may have an occasional PSA blood test, but not repeat prostate biopsies.
What Is Active Surveillance Or Watchful Waiting
Some prostate cancers are slow growing and might never cause you problems.
Your doctor might suggest waiting and seeing whether the cancer develops, rather than giving treatment straight away. All cancer treatments have side effects. So monitoring your cancer can help make sure you don’t have treatment that you don’t need.
You have regular tests to check whether the prostate cancer is staying the same size or starting to grow. You can start treatment if there is any sign that your cancer is beginning to change or grow.
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Tests To Expect During Watchful Waiting And Active Surveillance
Although watchful waiting implies that nothing will be medically done until necessary, your doctor will still check you regularly for signs and symptoms of a change in the tumor, such as difficulty urinating.. You may have some diagnostic tests, but they will be less invasive and less frequent compared to active surveillance. These are the tests you will have:
Prostate-Specific Antigen Blood Test:
This test measures the amount of PSA in your blood. Both normal and cancer cells in the prostate make PSA. A PSA level of less than 4 nanograms per milliliter of blood is considered healthy. Although men with a PSA lower than 4 can have prostate cancer, generally cancer develops when the PSA goes higher than 4.
Other conditions besides prostate cancer, such as an enlarged prostate, can raise PSA levels. During watchful waiting and active surveillance, your doctor will compare your most recent PSA test result with your previous one.
Digital Rectal Exam :
During this quick test, a doctor feels for bumps or hard areas on the prostate, which may indicate prostate cancer is growing. A DRE can also determine whether the tumor has grown outside the prostate.
Your doctor may suggest treatment if your Gleason score rises, your PSA level begins to increase, or you develop symptoms. These may include:
- Blood in the urine
What Happens During Active Surveillance
What happens during active surveillance depends on your local hospital. Your team can tell you more about what will happen. This is typically what might happen during year one of active surveillance. You might have a:
- blood test to monitor your PSA level every 3 to 4 months
- prostate examination at 12 months. You may not need this if you are having an MRI scan
- type of MRI scan called multiparametric MRI at 12 months
This is what might happen in year 2 and every year until active surveillance ends. You have a:
- blood test to monitor your PSA level every 3 to 6 months
- prostate examination. You may not need this if you are having an MRI scan
- MRI scan called multiparametric MRI
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Exceptions And Barriers To Active Surveillance
In his UCSF program, Dr. Cooperberg said, about 95% of men diagnosed with low-risk prostate cancer are put on active surveillance. As an academic center that began implementing and studying active surveillance in the mid-1990s, thats likely higher than what is typically seen in the United States, he acknowledged.
But a reasonable target for the time being is around 80%, he said. Thats consistent with where rates top out in countries like Sweden and in other large, integrated health care systems in Europe where active surveillance has long been standard practice.
The bottom line, Dr. Cooperberg said, is that even though the vast majority of men with low-risk prostate cancer should be put on active surveillance, there will always be exceptions.
Those exceptions, for example, can include men with a strong family history of prostate cancer or who have urological symptoms related to the disease that immediate treatment can help to alleviate.
There can also be considerations that go beyond clinical or biological factors. For patients in rural areas or those who lack reliable transportation, anything that requires regular visits to the hospital or doctors office over a long period could push some men toward choosing immediate treatment, Dr. Watts said.
In addition, she noted, it can be challenging to explain the medical basis for active surveillance. In some patients minds, opting for active surveillance means missing a window of opportunity for cure, she said.
Attitudes And Beliefs About Ww/as
Most men believed cancer should be treated and, better yet, cured as soon as possible because of the belief that any cancer, even slow-growing prostate cancer, would grow, spread, and kill if not treated. One man who did not know about WW/AS before our interview said that it would have scared me to death. Compared with aggressive treatment such as surgery or radiation, WW/AS was consistently referred to as doing nothing, and many men attributed this phrase to urologists.
Doctor said, you could do nothing, but I think you could have a problem later.
If you watch and do nothing, it is going to obviously progress. Its like, well, youre waiting for the time bomb to explode.
Im trying to think how he described it. I may not even have paid attention to it because when he mentioned it , it was like, No, we are not going to do that. I ruled that out immediately.
Some men thought WW/AS equaled burying your head in the sand or giving up.
If you want to live, you just have to make decisions to do things to extend your life if you can. But if you want to give up, you can give up or just wait and see.
I agree that I might die from something else, I just didnt want to roll the dice for me on that.
It seems logical, but Im not doing it. I want to get rid of this thing right now. I didnt want to give it a chance to do nothing. Youve got to crush that bug. Youve got cancer, man, you dont know what that things going to do.
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Watch The Moment We Sent Your Message To Government
With the NHS in crisis, we need to fight for men’s needs – nearly 15,000 signed our letter to the Health Secretary. We just delivered it.
With the NHS is in crisis – its more vital than ever that we fight for men with prostate cancer, give them a voice and make sure the Government understands their needs.That’s why, back in October, we asked you to sign a letter to the new Health Secretary, asking them to act now for the 475,000 men living with prostate cancer in the UK. We clearly laid out our priorities to improve testing, treatment and care. A couple of weeks back – armed with thousands of printed signatures and prepared to tell their own powerful stories – a team of our volunteers went to the Department of Health to drop off your letter. Watch what happened below.
The NHS is in crisis. Its more vital than ever that we fight for men with prostate cancer, give them a voice and make sure the Government understands their needs.Our volunteers went to the Department of Health and Social Care to hand in your letter calling for change.
Who Might Use Watchful Waiting
Doctors usually recommend watchful waiting for men who are older or who have other serious health problems. With watchful waiting, there are fewer tests. Instead, your doctor will watch to see if you get any prostate cancer symptoms. If you do, you and your doctor will talk about next steps. This could be treatments for the cancer. Or it could be treatments that will control the symptoms. The decision will be based on your age and other health problems.
Your doctor may suggest this method if:
- You have other health conditions that could make treatment too hard to handle.
- The prostate cancer probably wonât cause you any problems in your lifetime.
If you have symptoms, you and your doctor can decide at that time whether you need treatment.
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