Courtesy of Cedars-Sinai Los Angeles
Dale White was diagnosed with prostate cancer six years ago. His doctor told him that surviving prostate cancer depended on one treatment option: surgery.
"I was shocked. I thought that was too radical," said White, 69. "So I searched for other options and ended up at Cedars-Sinai, where Dr. Posadas told me I was a good candidate for active surveillance. That news changed my entire outlook about my cancer."
Active surveillance is a process in which men with low-risk, slow-growing prostate cancer are regularly monitored to see if the cancer starts to grow and requires treatment, said Edwin Posadas, M.D., medical director of the Urologic Oncology Program at Cedars-Sinai Cancer.
While prostate cancer surgery has been the go-to treatment for decades, today more men are opting to live with cancer that is regularly monitored. Because some types of prostate cancer are extremely slow-growing, active surveillance programs are now more acceptable to patients who want to avoid the potential risks of prostate surgery, which can include incontinence and erectile dysfunction.
Of the 165,000 men in the U.S. expected to be diagnosed with prostate cancer this year, according to the American Cancer Society, about half will have low-risk disease. Many of those patients -- about half, according to a 2016 study published in JAMA Oncology -- will opt for active surveillance.
Still, despite growing awareness about the low-impact treatment, there often is initial wariness about it, Posadas said.
"Dale had his qualms at first," Posadas said. "He, like some other patients, felt anxious about 'doing nothing,' as they view it. I tell them that we're actually doing plenty. It just doesn't involve a scalpel."
Active-surveillance monitoring includes repeated blood tests for prostate-specific antigen, a prostate biopsy, rectal examinations, and in certain cases, imaging and cancer genetic screening, said Posadas, co-director of the Translational Oncology Program. Magnetic resonance imaging of the prostate helps keep tabs on the size of the tumor and may determine if the cancer has spread. If the cancer grows or becomes more aggressive, the next step typically is surgery or radiation therapy.
(A Wellness Update is a magazine devoted to up-to-the minute information on health issues from physicians, major hospitals and clinics, universities and health care agencies across the U.S. Online at www.awellnessupdate.com.)