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Tuesday Q & A: Active surveillance reasonable approach for low-risk prostate cancer
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DEAR MAYO CLINIC: My father, 71, was diagnosed with early-stage prostate cancer last month. He is worried about the side effects of surgery and radiation, so he has instead decided to wait and see if the cancer progresses. His doctor agrees that he does not need to have treatment anytime soon. Should I have him get a second opinion?
ANSWER: Active surveillance is a reasonable approach for men with low-risk prostate cancer. However, prostate cancer has a wide range of possible treatment options. It is important to consider all the options before making a decision. Obtaining a second opinion often can be quite useful when deciding on the best approach.
Prostate cancer is common, particularly in older men, and it often grows slowly. Because of that, many men with prostate cancer actually die due to some other cause. About 1 in 6 American men are diagnosed with prostate cancer at some point in their lives, but only about 1 in 30 actually dies from the disease. Therefore, it is important to distinguish between the forms of prostate cancer that may not require treatment right away and those that may be aggressive and need to be addressed more quickly.
Choosing to hold off on treatment and instead closely monitoring prostate cancer through active surveillance may be a good choice when the cancer is small, expected to grow very slowly, confined to one area of the prostate and is not causing signs or symptoms. For older men or those who have another medical condition that limits life expectancy, active surveillance may also be the best option.
Active surveillance does require a commitment to follow-up appointments on the part of those who choose it. Most experts recommend regular blood tests, rectal exams and periodic prostate biopsies to see if the cancer is progressing. If, based on results of those follow-up tests, the cancer looks like it is growing, treatment may be performed at a later date.
If treatment is needed, a variety of options are available. As you noted, surgery to remove the prostate may be recommended. But other treatments can be used for prostate cancer, too. They include radiation therapy, hormone therapy and chemotherapy, among others. An individual’s specific treatment plan is developed based on a number of factors, such as how fast the cancer is growing, how much it has spread, and the person’s overall health. These factors combine to determine the benefits and the potential side effects of treatment.
Treatment for prostate cancer can cause side effects. Along with other possible complications, incontinence, or leaking urine, and erectile dysfunction can happen after surgery or radiation. The risk of these side effects can be lowered with state-of-the-art radiation therapy or when an experienced surgeon performs the procedure. If surgery is recommended, do not be hesitant to ask the surgeon how many of these surgeries he or she does each year. Surgeons who perform 50 or more a year typically have better outcomes than surgeons who perform fewer.
Keep in mind, too, that prostate cancer — even if it is an aggressive form of the disease — is not immediately life threatening. That means you can take time to talk to several physicians, get their recommendations and decide on the best approach for you.
You should never be afraid to ask for a second opinion. Most physicians understand and even encourage their patients to seek additional input if they have any hesitation or concerns about a diagnosis, recommended testing or treatment plan. If your surgeon or your doctor is offended by a request for a second opinion, you may want to consider switching to a different doctor. — Matthew Tollefson, M.D., Urology, Mayo Clinic, Rochester, Minn.
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