Men's Health
Active surveillance over prostate cancer treatment: Is it right for you?
More men are choosing active surveillance for their low-risk prostate cancer diagnosis. While this "wait and see" approach may sound passive, it can provide opportunities for men to get more active about their overall wellness.
What is active surveillance?
Active surveillance is a treatment option for men with low-risk prostate cancer as determined by two factors: cancer that only exists inside the prostate and specific findings on a prostate biopsy. During a prostate biopsy, the doctor usually takes 10 to 12 tissue samples. The samples are examined by a pathologist that confirms cancer is present and assigns a Gleason score.
The Gleason system assigns 1-to-5 rankings to the two most common types of cancer cells in a man's biopsied samples. The two rankings are added together to get a Gleason score, with 10 being the highest. The higher the number, the greater chance the cancer will quickly grow and spread. A low Gleason score -- typically a 6 and sometimes a 7 -- strongly suggests a low risk that the cancer will grow rapidly or spread.
Men on active surveillance regularly follow up with their doctor for PSA blood tests and digital rectal exams. The doctor may also order newer blood and urine tests, an MRI or a repeat biopsy. If there is evidence the cancer has progressed, such as a rising PSA, new findings on other tests or on MRI, or a repeat biopsy with a higher Gleason score, then treatment should be considered.
Why choose active surveillance?
The reason for choosing active surveillance is to defer="defer" immediate surgery or radiation, since low-grade prostate cancer is unlikely to progress. That also means avoiding possible side effects of treatment, such as erectile dysfunction, urinary incontinence, and bowel problems.
There is a good chance men with low-risk prostate cancer will live a long time so they should do everything they can to ensure their life is the healthiest and the highest quality it can be. Lifestyle changes, such as eating a Mediterranean or similar healthy diet, exercising more, and shedding pounds if you are overweight, could not only improve their long-term cancer outcome but also protect against other serious health issues like heart attacks and strokes.
For more information on preventing and treating prostate problems, check out the Guide to Prostate Diseases, a Special Health Report from Harvard Medical School.
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