Observation Or Active Surveillance For Prostate Cancer
Because prostate cancer often grows very slowly, some men who have it might never need treatment. Instead, their doctors may recommend observation or active surveillance.
The terms active surveillance and observation;mean something slightly different:
- Active surveillance is often used to mean monitoring the cancer closely. Usually this includes a doctor visit with a prostate-specific antigen blood test about every 6 months and a digital rectal exam at least once a year. Prostate biopsies and imaging tests may be done every 1 to 3 years as well. If your test results change, your doctor would then talk to you about treatment options to try and cure the cancer.
- Observation is sometimes used to describe a less intensive type of follow-up that may mean fewer tests and relying more on changes in a mans symptoms to decide if treatment is needed. This treatment is most often meant to control symptoms from the cancer, but not to cure it. ;
No matter which term your doctor uses, its very important for you to understand exactly what he or she means when they refer to it.
What Happens During Watchful Waiting
During watchful waiting, you could expect to run diagnostic tests now and then. Your doctor will not give you radiation therapy or chemotherapy. If youre on watchful waiting, chances are you are not a candidate for radical prostatectomy, either.
Instead, your treatment options are meant to control your urinary tract symptoms. It is the best approach for patients who are not candidates for aggressive treatment and do not have fast-growing cancer .
Strengths And Weaknesses Of The Study
To our knowledge, this study is one of the first to report on black men’s experiences and perspectives regarding WW/AS, about which little information has existed to date. We included participants with a wide range of education and socioeconomic backgrounds who consulted multiple specialists, including both urologists and radiation oncologists. This type of research may help to design further perspective studies of differences in patient perceptions of AS using a more standardized approach to explain the concept, for example, a video or third-party explanation of what AS entails, as well as possible risks and benefits. However, the study originally was designed to explore factors influencing treatment decisions among men with LPC of all risk levels, not specifically men with low-risk disease. In addition, our study sample is younger than those reported previously,,, which may explain few of our men choosing WW/AS. Other limitations include the qualitative sample with possible selection bias and unknown recall bias. Also, we do not know if the physicians of study participants had a consistent understanding and use of the terms watchful waiting and active surveillance.
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What Is Watchful Waitings Role In The Treatment Of Certain Kinds Of Prostate Cancer
Your doctor will probably recommend watchful waiting in the following conditions :
- In fragile patients who are not candidates for aggressive treatment.
- When prostate cancer is not causing alarming symptoms.
- In prostate cancer with a favorable Gleason score.
- When the tumor is small, and only located in the prostate .
- If your PSA levels are lower than 10 ng/ml.
In this type of prostate cancer, some clinical trials show that there is no difference in survival rate if you are performed prostatectomy or not. Thus, instead of treating cancer, doctors treat the symptoms. To watch out for any change, they maintain patients under observation.
Targeted Prostate Biopsy Program At Ucla
UCLA Medical Center has been on the forefront a new technology that may provide a vastly improved prostate biopsy.; The prostate-imaging technology that fuses MRI with real-time, three-dimensional ultrasound appears to offer a more exacting method to obtain biopsy specimens from suspicious areas within the organ.; The targeted prostate biopsy program has advanced the science of performing prostate biopsies, which until now, have not changed since the mid-1980s.;
Four UCLA departments urology, radiology, pathology and biomedical engineering collaborated with the medical device company Eigen Inc. to develop and test the technology. The team’s early experiences with it are reported in the online MayJune;issue of Urologic Oncology 2011. The technology may be most beneficial for patients who fall into one of two categories: those who had prior negative biopsies but have persistently elevated prostate-specific antigen levels, and “active surveillance” patients those with low-risk prostate cancers who are being carefully monitored over time to see if their cancer progresses or becomes more aggressive.
Active Surveillance for Prostate Cancer, Dr. Leonard Marks
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Active Surveillance Watchful Waiting What Every Man With Prostate Cancer Should Know
Oleksandr N. Kryvenko, MD, FCAP, is Assistant Professor of Pathology and Urology at the Sylvester Comprehensive Cancer Center, University of Miami Health System, in Miami, FL.
Theres a member of your health care team who plays a vital role in your diagnosis and cancer care who you may never meet face to face: the pathologist. This is the doctor who analyzes the sample of tissue removed during a biopsy to make the correct diagnosis.
As a pathologist specializing in prostate cancer, I know that any cancer diagnosis is alarming. Men diagnosed with prostate cancer may be even more alarmed if active surveillance and watchful waiting come up. Their very names sound like the opposite of what should be done in cancer treatment. But understanding these 2 approachesand their differencescan help you make informed decisions as you consider prostate cancer treatment plans.
What Are The Advantages
The biggest advantage to watchful waiting is avoiding the surgery or radiation therapy that is associated with more aggressive versions of the cancer. Not all cancers move at the same rate, and not all grow to become a danger to other tissue. This is also a good method to consider for early stages of the cancer if the cancer is not growing rapidly.
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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.
Prostate Cancer: Moving Beyond Watchful Waiting
Prostate cancer is the second-leading cause of cancer death in American men: the American Cancer Society expects the disease will claim nearly 30,000 lives in 2013. The disease mainly affects older menthe median age of diagnosis is 67and its a slow-growing cancer, so most men diagnosed with the disease are likely to die of other causes.
Brad Davis, a veterinarian with a family history of prostate cancer, was diagnosed at age 54. A blood test he had taken showed elevated levels of prostate-specific antigen , a protein that may indicate the presence of the disease, and a biopsy confirmed the diagnosis.
This put me in a quandary, says. Davis, who knew he had many active years still ahead, and was concerned that surgery or radiation could compromise them. Still, he was young enough that the cancer, if left unchecked, could eventually kill him.
Just a few years ago Daviss options would have been limited to watchful waiting or prostatectomy to remove part or all of his prostate. But thanks to advances in prostate cancer treatment, his Yale doctors were able to offer a relatively new, middle-of-the-road approach called active surveillance.
When Peter G. Schulam, M.D., Ph.D., came to Yale from the University of California at Los Angeles in 2012 as professor and chair of the School of Medicines newly formed Department of Urology, one of his first actions was to assemble the team and equipment necessary to perform active surveillance.
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What Are The Risks And Rewards Of Watchful Waiting
According to the findings of a 15-year study published in The New England Journal of Medicine, men with localized early-stage prostate cancer who chose watchful waiting instead of surgery for their cancer had the same prostate cancer mortality rate or overall death rate as did men who chose surgery.
So why would you want to undergo surgery and live with significant side effects rather than follow watchful waiting? The studys lead author, Dr. Timothy J. Wilt, professor of medicine at University of Minnesota School of Medicine, remarked that This study adds to growing evidence that observation can be a wise and preferred treatment option for the vast majority of men. It allows them to live a similar length of life and avoid death from prostate cancer and avoid the harms of treatment.
One expert who has been a pioneer in reversing serious disease, including heart disease and prostate cancer, is Dean Ornish, MD, who has shown that watchful waiting combined with comprehensive lifestyle changes can have a dramatic effect on prostate cancer. In a study headed by Ornish, 93 men with early prostate cancer were assigned to traditional care or an experimental group, in which the men adopted lifestyle changes.
Both of these changes were significantly associated with the extent men changed their diet and lifestyle. The authors concluded that Intensive lifestyle changes may affect the progression of early, low grade prostate cancer in men.
Pros And Cons Of Watchful Waiting For Prostate Cancer
The following are the advantages of watchfully waiting for your prostate cancer to metastasize:
- You won’t have to undergo treatments and regular tests for prostate cancer.;
- You won’t have to endure the side effects of treatment.
- Symptoms may never show up. You may never have to be treated.
- If symptoms do manifest, you and your oncologist can then create a prostate cancer treatment plan.
The following are the disadvantages of watchful waiting:
- The tumor won’t be actively monitored, so it may grow sooner than expected.
- You may feel anxiety over the uncertainty of your condition.
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Tests Performed During The Watch And Wait Period
During the watch and wait period, youre not meant to undergo surgery or radiation therapy. However, you will need to perform a series of tests to follow-up on your condition.
During this period, the doctor will ask for new follow-up tests every 6 to 12 months. The patient will be asked to monitor your symptoms and report any change, too.
The tumor may be changing if you start having urinary symptoms or experience sudden weight loss. Thus, it is recommended to report these symptoms regardless of the date of your next appointment.
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. It’s like, well, you’re waiting for the time bomb to explode.
I’m 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 didn’t want to roll the dice for me on that.
It seems logical, but I’m not doing it. I want to get rid of this thing right now. I didn’t want to give it a chance to do nothing. You’ve got to crush that bug. You’ve got cancer, man, you don’t know what that thing’s going to do.
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Watchful Waiting And Prostate Cancer Patients
Patients who wish to pursue watchful waiting usually have these characteristics:
- Low PSA veloctiy
- Nonpalpable tumor during DRE
- No genetic predisposition for prostate cancer
- Uncharacteristically young, or much older and wishing to avoid side effects that come with more aggressive treatments
Watchful waiting is not for everyone. Read on to see who is opting for watchful waiting and why. Patients should speak with a doctor about whether watchful waiting can benefit them.
Watchful Waiting as First Line Therapy for Prostate Cancer Prostate cancer, specifically prostatic adenocarcinoma, usually grows very slowly. Early stages of tumors may actually grow so slowly or be so small that beginning an aggressive treatment would do a patient more harm than good.
Watchful waiting as a prostate cancer treatment may be recommended for those with very low Gleason scores or low PSA velocities. Some patients with small low grade tumors may wish to use watchful waiting and postpone more aggressive treatments. Some patients feel that watchful waiting increases the quality of a patients life by avoiding the side effects associated with all other forms of prostate cancer treatments.
Many men die with prostate cancer as opposed to dying from prostate cancer. Autopsies of men who died of natural causes indicate the presence of prostate cancer that these men never knew they had. Watchful waiting can be a valuable therapy as both a primary and salvage treatment.
What Do You Risk With Watchful Waiting
But regardless of your Gleason score, and your prognosis, there are some risks you need to be aware of :
- Theres always a chance that the characteristics of cancer change, and it starts to grow.
- It can be a source of distress for men who feel they should get aggressive prostate cancer treatment instead.
- The stress and concern are share and fed by family members who think surgery is the best option.
- Keep in mind theres always a relative risk. Thus, doctors make decisions based on a balance between benefits and risk. The majority of cases of prostate cancer do not grow rapidly. But others may change their phenotype and become aggressive. Thats why active surveillance is what stays between aggressive treatment and watchful waiting. It is another option for healthier or younger patients, candidates for prostatectomy.
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What Are The Advantages Of Watchful Waiting
Watchful waiting is recommended in cases of localized prostate cancer because it offers the following benefits :
- Patients with other health conditions are not aggravated by the side effects of radiation therapy and similar treatments.
- The prostate biopsy is not a routine exam.
- It is a useful way of monitoring prostate cancer symptoms and provides early treatment.
- It reduces stress levels in men and may improve their quality of life.
- Most men realize after a while; they dont really need any treatment to stay safe.
Chances Of Cancer Progressing During Watching Waiting
The chances of your cancer progressing during watchful waiting is a common concern that you may have. This particular subject is still being studied, but based on the information we have, about 30-40% of men will undergo treatment within ten years following their prostate cancer diagnosis. This is typical because the cancer progresses or the patient gets too nervous and wants to be treated. While it is possible, it is very uncommon for patients to die from issues related to prostate cancer during watchful waiting. The concept here is that you and your primary care physician or urologist closely monitor the cancer and create adjustments to your care as needed.
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What Is Watchful Waiting For Patients With Prostate Cancer
In some patients, particularly older men or men with other severe health problems, prostate cancer develops and progresses slowly. In these cases, physicians may prefer to wait before treatment or not to treat them at all. Instead, their doctors may recommend approaches known as;expectant management,;watchful waiting,;observation, or;active surveillance, explains the American Cancer Society. Some doctors use these terms to mean the same thing. For other doctors the terms active surveillance and watchful waiting mean something slightly different.
Active surveillance refers to a close;monitoring of the cancer growth through;prostate-specific antigen blood tests, digital rectal exams , and ultrasounds at regular intervals. Watchful waiting or observation, on the other hand, consists on a less intensive type of follow-up including less tests and more based on the patients symptoms. Not all doctors agree with these definitions or use them exactly this way. In fact, some doctors prefer to no longer use the term watchful waiting. They feel it implies that nothing is being done, when in fact a man is still being closely monitored.;No matter which term your doctor uses, its very important to understand exactly what he or she means when they refer to it.
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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