Annual Report On Prostate Diseases
Most men eventually develop some type of prostate problem, and when they do there are usually no easy solutions. More than a primer on prostate conditions, this Special Health Report, the Annual Report on Prostate Diseases, includes roundtable discussions with experts at the forefront of prostate research, interviews with men about their treatment decisions, and the latest thinking on complementary therapies. This report will provide you with the information you need to understand the current controversies, avoid common pitfalls, and work with your doctor to make informed choices about your prostate health.
Get the latest in health news delivered to your inbox!
Thanks for visiting. Don’t miss your FREE gift.
The Best Diets for Cognitive Fitness, is yours absolutely FREE when you sign up to receive Health Alerts from Harvard Medical School
Sign up to get tips for living a healthy lifestyle, with ways to fight inflammation and improve cognitive health, plus the latest advances in preventative medicine, diet and exercise, pain relief, blood pressure and cholesterol management, and more.
Health Alerts from Harvard Medical School
Get helpful tips and guidance for everything from fighting inflammation to finding the best diets for weight loss…from exercises to build a stronger core to advice on treating cataracts. PLUS, the latest news on medical advances and breakthroughs from Harvard Medical School experts.
Stay on top of latest health news from Harvard Medical School.
Who Has Active Surveillance
You might have active surveillance if:
- your cancer is contained in the prostate gland. This is localised prostate cancer
- you have a Cambridge Prognostic Group of 1, 2 or 3. This is similar to a low or medium risk localised prostate cancer
- you can have treatment that aims to cure if the cancer starts to grow
Your doctor will discuss the possible benefits and risks of active surveillance. They make sure that you’re happy with whichever decision is made.
Prostate Cancer: Watch And Wait
A study from Washington University School of Medicine in Saint Louis has shown that men with low-risk prostate cancer might be better off choosing observation of the tumor rather than surgical removal. In the study group, men diagnosed with low-risk prostate cancer who had surgery to remove the tumor did not live significantly longer than patients who did not have the surgery.
In 1994, a blood test called prostate-specific antigen was introduced. The test made detection of early stage prostate cancer much easier. Doctors are able to identify many cases of prostate cancer that would otherwise go unnoticed. However, low-risk prostate cancer is a common occurrence among men. It is thought that many of these cancers will not cause the patient harm. Patients should always make informed decision, and discuss the risks and benefits of different types of treatment with their doctors.
Don’t Miss: Alternatives To Prostate Needle Biopsy
Men Who Follow Active Surveillance Or Watchful Waiting For Their Low
More men are choosing active surveillance or watchful waiting for their low-risk prostate cancer diagnosis. While these two “wait and see” approaches may appear passive, they can provide opportunities for men to get more active about their overall wellness.
“There is a good chance men will live a long time with low-risk prostate cancer, and they should do everything they can to ensure their life is the healthiest and the highest quality it can be,” says Dr. Jacob Berchuck, an oncologist with Harvard-affiliated Dana-Farber Cancer Institute.
To continue reading this article, you must log in.
- Research health conditions
- Prepare for a doctor’s visit or test
- Find the best treatments and procedures for you
- Explore options for better nutrition and exercise
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.
Recommended Reading: 10 Early Warning Signs Of Prostate Cancer
Who Should Choose Active Surveillance
Some of the characteristics that might qualify you for Active Surveillance include grade group 1 or Gleason 6, a PSA level < 10, cancer that is confined to the prostate, and/or cancer that is very low volume when biopsied.
The ideal candidate for Active Surveillance has low-risk prostate cancer. Learn more about Risk Groups.
Prostate Cancer Watch And Wait
- Posted on:
Stunned. Distressed. Angry. These may be some of the emotions that you may be feeling after receiving a diagnosis of prostate cancer. The C-word strikes fear into the hearts of all people and does not discriminate on the basis of race, ethnicity, religion, sex, or sexual orientation. It hits you in your core.
Typically, once a prostate cancer diagnosis is made, the next step is to talk with your doctor about scheduling radiation and chemotherapy, possible removal of the prostate gland, and what your prognosis is with those treatments. Weeks or months of uncertainty will follow along with side effects from treatments, but with your strong resolve and the strength of your friends and family, youll get through this.
However, what if, following your prostate diagnosis, your doctor says that the plan is to just watch and wait? Could you do it? Could you risk deviating from the typical plan?
Many prostate cancer doctors are finding merit in the active monitoring plan which involves screenings, blood tests and prostate biopsies, but no traditional treatment.
A recent 10-year study by the Prostate Testing for Cancer and Treatment group held a study of over 1,600 men in the United Kingdom with a median age of 62. The study was focused on finding the merit in the active surveillance approach.
Not all prostate cancer experts completely agree with the findings of the U.K. study.
Also Check: What Percentage Of Males Get Prostate Cancer
How Do Doctors Know Whos A Good Candidate For Active Surveillance
Pathologists on the cancer care team are critical to determining whether active surveillance is a good fit for individual patients. Pathologists report specific details that help determine whether the approach is a safe alternative to immediate treatment. The approach may be an option if a patient has a:
-
PSA density of less than 0.15
-
Low volume of localized cancer
-
Biopsy Gleason score of 3+3=6
Doctors also take into account other factors, including the cancers stage and the patients age, health, family history, and personal preference. A patients race and ethnicity are also important factors. Recent clinical studies found that PSA levels and tumor size among black men with prostate cancer vary distinctly from those among white men with prostate cancer.
In other words, the doctor and the patient make a joint decision based on the information the pathologist provides and a patients individual factors.
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.
Also Check: What Happens When A Man Has Prostate Cancer
Active Surveillance For Prostate Cancer
Early-Stage Prostate Cancer Patients “Watch and Wait”
More men diagnosed with early stage prostate cancer are choosing to defer treatment, preferring to monitor the status of their cancer by having regular exams and tests that are designed to let them know if they need to be treated or if they can continue to hold off.
The strategy used to be called watchful waiting but is now more often referred to as active surveillance when it refers to younger men.
In years past, physicians often encouraged men in their 70s and 80s to adopt the watchful waiting strategy. This was because prostate cancer usually grows slowly, and there was a good change that they would die from other causes.
But there has been a sea change in the thinking about the need for prostate cancer treatment. Today at BIDMC, more than 50 percent of younger men are adopting the active surveillance strategy. Ten years ago, only five to 10 percent of younger patients with low-grade, early stage prostate cancer were choosing to watch and wait.
A number of landmark studies in that time have shown the strategy is safe.
BIDMC Urologists Open-Minded
The urologists at BIDMC are in tune with the thinking that active surveillance is a safe strategy for appropriate patients. There are still urologists at other institutions who dont share this confidence. Many still tell their patients they need immediate treatment.
Guidelines for Good Candidates
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 they mean when they refer to it.
You May Like: What Color Is Prostate Cancer
Prostate Cancer: Watchful Waiting Vs Active Surveillance
About one out of every eight men will be diagnosed with prostate cancer during his lifetime, making it the second most common cancer in American men, behind only skin cancer.1 However, due to advances in cancer screening awareness and early detection, most men will not die from prostate cancer. In fact, many men who are diagnosed with an early-stage, low-grade cancer may need little to no immediate medical treatment. Instead, they can choose from two different methods of monitoring their prostate cancer: watchful waiting or active surveillance.
For men with prostate cancer, the goal of cancer management methods like watchful waiting and active surveillance is to avoid the side effects caused by cancer treatments like surgery or radiation therapy.
Both watchful waiting and active surveillance are ways of monitoring the cancer for changes, but the reasons for choosing one method over the other are different:
- Watchful waiting is better for men who cant undergo curative treatment. It is meant to manage symptoms by controlling the cancer, but is not intended to cure it.
- Active surveillance is better for men who would benefit from curative treatment should the cancer become more aggressive.
Prostate cancer patients may wish to forgo immediate treatment, and instead use watchful waiting or active surveillance when:
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.
Related Links
You May Like: Last Stages Of Prostate Cancer What To Expect
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
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.
Read Also: How Big Is A Normal Prostate
What Does Watchful Waiting Involve
If youre on watchful waiting you will have tests to monitor your cancer. You wont have any treatment unless you get symptoms.
Youll normally have a prostate specific antigen blood test at your GP surgery or hospital clinic every 6 to 12 months. This will help to check for any changes to your prostate cancer.
You might also have digital rectal examinations and other blood tests. You probably wont need to have regular scans or prostate biopsies.
If any changes are picked up by these tests or you have any new or different symptoms, you may be given an appointment with the doctor or nurse at the hospital.
What symptoms should I look out for?
You should let your GP or doctor or nurse at the hospital know if you notice any symptoms or changes to your health. Things to look out for include:
- any changes to your urinary habits, for example needing to urinate more often, especially at night
- problems urinating such as a weak or slow flow
- blood in your urine
- unexplained weight loss
- new swelling in your legs.
Ask your doctor or nurse if there are any other symptoms or changes to your health that you should look out for, as well as who to contact about them.
What happens if I get symptoms?
If you start to notice any of these symptoms you might need more tests to see if your cancer has spread, and you may be offered treatment.
> > > One Crazy Prostate Trick All Men Over 40 Should Try
Symptomatic treatment of an enlarged prostate usually involves a combination of medication and lifestyle changes. A diet rich in fruits and vegetables may be the best option if you suffer from chronic urination. It will help the body adjust to the increased size of the prostate. Also, taking regular urination intervals will help retrain the bladder to function properly. Inactivity also contributes to urine retention, and cold temperatures can increase the urge to urinate.
Invasive treatment of enlarged prostate includes medication that relieves the pressure on the urethra and bladder. However, if the condition is severe, it may require surgical intervention. If treatment is not successful, the enlarged prostate can become a potentially life-threatening disease. As the hormone levels in the body change, the enlarged prostate can lead to various complications, including urinary retention and even cancer. This is why it is critical to see a doctor for further evaluation.
Read Also: Which Is Better Prostate Surgery Or Radiation