The adage “trust but verify” is an appropriate description of active surveillance for low-risk prostate cancer.
Many men who are diagnosed with low-risk prostate cancer opt for active surveillance – closely monitoring the cancer over time in order to avoid treatments whose side effects negatively affect their quality of life. About one-third of prostate cancer patients at Stephenson Cancer Center at OU Medicine are on active surveillance, said urologic cancer surgeon Michael S. Cookson, M.D.
“Prostate cancer can certainly be lethal, but more men are diagnosed and live with prostate cancer than will die of it,” said Cookson, who is also chairman of the Department of Urology at the OU College of Medicine. “For those cancers that are slow-growing, we monitor them. If we find something potentially aggressive, then we begin treatments.”
Prostate cancer falls into three risk categories – low, intermediate and high. Patients diagnosed with intermediate- and high-risk cancers usually undergo treatment, but because of the location of the prostate, their urinary control and sexual function may be negatively affected.
Patients with low-risk prostate cancer can avoid those side effects through active surveillance. Low-risk patients typically have the lowest Gleason score – 6 — which indicates the cancer is unlikely to grow. Their prostate-specific antigen (PSA) test scores are usually less than 10, and the cancer typically can’t be felt during an exam. Genetic testing can further confirm their level of risk.
Active surveillance involves patients returning to the clinic regularly for PSA and symptom checks. Around six to 12 months, they return for an MRI and a confirmatory biopsy. If nothing has changed with their cancer, patients can return less frequently for the biopsy while still having regular PSA and symptom checks.
“With low-risk prostate cancer, changes occur over years, if not decades. It’s slow-growing; that’s why it can be safely observed,” Cookson said. “We believe men who have tumors that are not threatening deserve to enjoy the fullest life that they can.”
Active surveillance also involves guiding men to make the healthy decisions that will increase their odds of maintaining good quality of life. Studies of low-risk prostate cancer patients have shown that their No. 1 health threat is heart disease, Cookson said. Urologists encourage their patients to maintain a healthy weight, exercise, monitor their cholesterol, get colonoscopies and have heart exams.
“Many men come to us with a prostate cancer concern, and that visit becomes an entry point to healthcare for them,” Cookson said. “We become their trusted confidant in helping them to navigate the healthcare system and advocating for their entire health.”