Jacksonville Prostate Cancer

This question brings up an important point with
regard to “watchful waiting” or “active surveillance”
as a means of managing prostate cancer. Multiple
factors have to be evaluated when considering
this option, including age, general health status,
concurrent medical problems as well as prostate
cancer characteristics. Generally, watchful waiting
or active surveillance is reserved for men with low
volume, low grade prostate cancer, a low PSA and no
evidence of cancer outside of the prostate. Some of
the criteria we look at as urologists when considering
active surveillance as an option for a gentleman with
prostate cancer include the following:
1. Cancer stage of T1 (no nodule) or T2a (nodule
involving one-half or less of one lobe of the prostate)
2. Gleason score 3. PSA 4. < 3 biopsy cores positive for cancer (none greater
than 50% cancer).
The most important part of an active surveillance
protocol is the actual“active surveillance.” What does
this mean? This means that we have to watch the
prostate cancer very closely.
An active surveillance protocol includes frequent
follow-up evaluations with PSA tests and digital
rectal examinations every 3 months for 2 years and
then every 6 months after that assuming everything
remains stable. Another recommendation includes
prostate biopsy at one year following diagnosis and
then every 3 to 5 years until the age of 80. The reason
for this close monitoring is to ensure that any changes
in the characteristics of the prostate cancer are picked
up early. That being said, what changes are considered
important?
In this protocol, if the PSA level doubles in less
than 3 years, if there is a change in digital rectal
examination, or if the Gleason score increases on
repeat biopsy (especially to Gleason 4+3=7 or higher),
some form of treatment should be considered.
Management options were previously discussed
here in August and include androgen deprivation
therapy, surgery (open, laparoscopic or robotic daVinci
prostatectomy), brachytherapy (“seed implants’),
external beam radiation therapy, proton beam therapy,
high frequency ultrasound of the prostate (HIFU) and
cryotherapy. As always, be sure to discuss all of these
options with your urologist including the risks,benefits
and alternatives to each before making an informed
decision regarding treatment of your prostate cancer.
To answer your specific question, you and your
husband need to schedule an appointment with your
urologist to further discuss the importance of actively
monitoring your prostate cancer as a part of an active
surveillance protocol. Another essential consideration
will be your husband’s comfort level with this
management option. Maintain open and honest
discussions with your doctor when considering this
or any treatment option for your husband’s prostate
cancer.
It important to remember that the key to
management of prostate cancer is finding the treatment
that suits you and your particular cancer the best.
With an active surveillance protocol, it is important to
be active and closely monitor your prostate cancer so
that any changes are caught early when our treatments
have the best chance for success.